Systematic Review of Associations Between the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging and Clinical Predictors of Early Stroke Risk After Transient Ischemic Attack

Redgrave, Jessica; Coutts, Shelagh B.; Schulz, Ursula G.; Briley, Dennis; Rothwell, Peter M.

doi:10.1161/strokeaha.106.477380

Cited by 162 publications

(107 citation statements)

References 40 publications

(76 reference statements)

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“…19 Other factors previously associated with DWI lesions, including speech impairment, atrial fibrillation, and ICA stenosis Ն50%, were not confirmed in our study.…”

contrasting

confidence: 69%

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Yield of combined perfusion and diffusion MR imaging in hemispheric TIA

Mlynash¹,

Olivot²,

Tong³

et al. 2009

Neurology

111

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Objective: Transient ischemic attacks (TIA) predict future stroke. However, there are no sensitive and specific diagnostic criteria for TIA and interobserver agreement regarding the diagnosis is poor. Diffusion-weighted MRI (DWI) demonstrates acute ischemic lesions in approximately 30% of TIA patients; the yield of perfusion-weighted MRI (PWI) is unclear. Methods:We prospectively performed both DWI and PWI within 48 hours of symptom onset in consecutive patients admitted with suspected hemispheric TIAs of Ͻ24 hours symptom duration. Two independent raters, blinded to clinical features, assessed the presence and location of acute DWI and PWI lesions. Lesions were correlated with suspected clinical localization and baseline characteristics. Clinical features predictive of a PWI lesion were assessed. Results:Forty-three patients met the inclusion criteria. Thirty-three percent had a PWI lesion and 35% had a DWI lesion. Seven patients (16%) had both PWI and DWI lesions and 7 (16%) had only PWI lesions. The combined yield for identification of either a PWI or a DWI was 51%. DWI lesions occurred in the clinically suspected hemisphere in 93% of patients; PWI lesions in 86%. PWI lesions occurred more frequently when the MRI was performed within 12 hours of symptom resolution, in patients with symptoms of speech impairment, and among individuals younger than 60 years. Transient ischemic attacks (TIA) are defined as sudden, temporary attacks (Ͻ24 hours) with focal symptoms attributable to dysfunction of one artery of the brain. The risk of stroke after a TIA is up to 10% in the first week following symptom onset. Conclusions:1 Recent studies demonstrated that a prompt etiologic investigation followed by the initiation of an appropriate prevention strategy can substantially reduce this risk.2,3 Hence, confirmation of the diagnosis of TIA is a major challenge since in most cases the clinical deficit has resolved at the time of evaluation and conventional brain imaging does not detect most conditions that masquerade as a TIA. 4 In multimodal MRI, diffusion-weighted imaging (DWI) demonstrates the presence of severe cytotoxic ischemic injury within minutes, which provides an estimate of the ischemic core, 5,6 and perfusion-weighted imaging (PWI) provides an assessment of cerebral hemodynamics.

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“…19 Other factors previously associated with DWI lesions, including speech impairment, atrial fibrillation, and ICA stenosis Ն50%, were not confirmed in our study.…”

contrasting

confidence: 69%

“…[8][9][10][11][12][13][14][15][16][17][18] These studies were recently compiled in a systematic review. 19 The rate of positive DWI varied from 16 to 67% among suspected TIA cases. Therefore, DWI appears to be a valuable tool to confirm an ischemic etiology in patients with transient neurologic focal symptoms.…”

mentioning

confidence: 99%

Yield of combined perfusion and diffusion MR imaging in hemispheric TIA

Mlynash¹,

Olivot²,

Tong³

et al. 2009

Neurology

111

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show abstract

“…Molecular and cellular processes responsible for plaque composition [94][95][96] may be more important than the degree of stenosis in determining the risk of stroke, but the severity of stenosis forms the basis for most clinical decision making.…”

Section: Clinical Presentationmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Brott

Halperin

Abbara

et al. 2011

Cathet Cardio Intervent

185

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“…15 Although developed for use in cohorts of patients before investigation, the possibility has been raised that prognostication might be improved after evaluation in secondary care by the incorporation of information from investigations, particularly the presence of brain infarction on imaging. 3,6 However, patients with high ABCD 2 scores are more likely to have brain infarction on diffusion-weighted imaging (DWI) 16 and so the additional predictive value of a composite score is uncertain. Studies published thus far have been too small to address this issue reliably, far too small to determine appropriate weighting for any imaging features, and meta-analysis of published data is undermined by inconsistent definitions of abnormality on imaging.…”

mentioning

confidence: 99%

Addition of Brain Infarction to the ABCD ² Score (ABCD ² I)

Giles

Albers

Amarenco

et al. 2010

Stroke

Self Cite

158

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Background and Purpose-The ABCD system was developed to predict early stroke risk after transient ischemic attack.Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the prognostic performance of the ABCD 2 score and brain infarction on imaging to determine the optimal weighting of infarction in the score (ABCD 2 I). Methods-Twelve centers provided unpublished data on ABCD 2 scores, presence of brain infarction on either diffusion-weighted imaging or CT, and follow-up in cohorts of patients with transient ischemic attack diagnosed by World Health Organization criteria. Optimal weighting of infarction in the ABCD 2 I score was determined using area under the receiver operating characteristic curve analyses and random effects meta-analysis. Results-Among 4574 patients with TIA, acute infarction was present in 884 (27.6%) of 3206 imaged with diffusion-weighted imaging and new or old infarction was present in 327 (23.9%) of 1368 imaged with CT. ABCD

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Systematic Review of Associations Between the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging and Clinical Predictors of Early Stroke Risk After Transient Ischemic Attack

Cited by 162 publications

References 40 publications

Yield of combined perfusion and diffusion MR imaging in hemispheric TIA

Yield of combined perfusion and diffusion MR imaging in hemispheric TIA

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Addition of Brain Infarction to the ABCD ² Score (ABCD ² I)

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Systematic Review of Associations Between the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging and Clinical Predictors of Early Stroke Risk After Transient Ischemic Attack

Cited by 162 publications

References 40 publications

Yield of combined perfusion and diffusion MR imaging in hemispheric TIA

Yield of combined perfusion and diffusion MR imaging in hemispheric TIA

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Addition of Brain Infarction to the ABCD 2 Score (ABCD 2 I)

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Addition of Brain Infarction to the ABCD ² Score (ABCD ² I)