Incidence and Predictors of Acute Ischemic Lesions on Brain Magnetic Resonance Imaging in Patients With a Clinical Diagnosis of Transient Ischemic Attack in China

Abstract

Background: The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients. Methods: Between Jan 2017 and Dec 2018, we retrospectively enrolled 430 patients with a clinical diagnosis of TIA who underwent DWI. Patients were divided into those with acute ischemic lesions (DWI positive group) and those without (DWI negative group). The clinical characteristics, laboratory data, and imaging parameters were compared between the two groups. Results: A total of 430 time-based TIA patients (mean age, 61.4 ± 13.0) were enrolled in this study. About 126 (29.3%) of TIA patients had a DWI positive lesion in our series. Comparing TIA patients with positive DWI to those with negative DWI, acute lesions were more likely to be more male, have higher hyperlipidemia and a smoking history, more speech abnormalities and increased motor weakness; and higher systolic and diastolic blood pressure, homocysteine, fasting blood glucose, and the scores of ABCD2, ABCD3, ABCD3-I, and Dawson. Several independent predictors of DWI positivity were identified with logistic regression analysis: motor weakness (odds ratio 4.861, P = 0.021), speech abnormalities (odds ratio 4.029, P = 0.024), and ABCD3-I (odds ratio 13.141, P = 0.001). ABCD3-I showed the greatest area under the ROC curve, with a sensitivity of 85.7% and specificity of 72.4%. Conclusion: In patients with a clinical diagnosis of TIA, 29.3% demonstrated acute DWI lesions on brain magnetic resonance imaging (MRI). They were associated with motor weakness, speech abnormalities and higher ABCD3-I score at admission.

Incidence of first‐ever transient ischemic attack in Eastern Finland

“…Very few published reports have used tissue‐based TIA criteria, and no study has compared TIA incidence rates obtained using time‐based versus tissue‐based criteria using recommended neuroimaging, diffusion‐weighted MRI. In a Chinese single‐center study, the DWI was used for each time‐based TIA patient; however, the report focused on DWI lesions, and TIA incidence was not reported 36 . An Italian report showed slight variation in the TIA incidence when time‐based TIA criteria (incidence 28.6/100,000) were compared to tissue‐based criteria (incidence 20.0/100,000) 18 .…”

“…In previous reports, DWI has been carried out in 14.3%–100% of TIA patients. 18 , 23 , 33 , 34 , 35 , 36 In our hospital, we normally perform CT scanning in TIA patients due to the limited availability of MRI imaging.…”

A Novel Clinical Nomogram to Predict Transient Symptomatic Associated with Infarction: The ABCD3-SLOPE Score

“…Our study suggested 41.3% of the patients with transient neurologic deficits had positive DWI lesions on brain MRI. The rate of TSI in our research was [3][4][5][6][7]. The high incidence of TIS prompted us to develop a practical tool to identify TSI in patients with transient symptoms at the onset of stroke.…”

“…Although the nomogram model demonstrated reasonable accuracy for the prediction of TSI, there are some limitations. First, the time delay from symptom onset to MRI examination is an essential factor that affects DWI positivity [3], and some patients might be underestimated if the MRI was performed within 24 hours of symptom onset. The time should be classified in the further study.…”

“…A transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction, has been defined as a TIA [1,2]. With the advent of diffusion-weighted imaging (DWI), it was reported that 29.3-41.5% percent of patients with transient clinical deficit had positive DWI [3][4][5][6][7]. To data, the normative definition for these DWI-positive cases was not yet well-established, while it was termed transient symptoms associated with infarction (TSI) [6].…”