Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack

• Published in: Stroke (1970) 2020-01, Vol.51 (1), p.186-192
• Main Authors: Nam, Ki-Woong, Kim, Chi Kyung, Ko, Sang-Bae, Yoon, Byung-Woo, Yoo, Roh-Eul, Sohn, Chul-Ho
• Format: Article
• Language: English
• Subjects: Aged; Diffusion Magnetic Resonance Imaging; Female; Humans; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - epidemiology; Male; Middle Aged; Perfusion Imaging; Registries; Spin Labels
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.119.026556

Background and Purpose- With the lack of confirmatory examinations, the distinction of a transient ischemic attack (TIA) from various TIA-mimicking diseases is difficult, particularly in diffusion-weighted imaging (DWI)-negative TIAs. In this study, we aimed to evaluate the relationship between arterial spin labeling (ASL) perfusion defects and early ischemic recurrence (FU-DWI [+]) in patients with DWI-negative TIAs. Methods- We assessed consecutive patients with a DWI-negative TIA within 24 hours of symptom onset, who underwent both ASL images and follow-up magnetic resonance imaging during the acute period. As markers of the ASL images, we evaluated the ASL perfusion defects in each hemisphere. Arterial transit artifact (ATA) and intraarterial high-intensity signal (IAS) were also rated as markers of collateral status and blood stagnation due to large vessel occlusion, respectively. Results- Among the 136 patients with a DWI-negative TIA, 33 patients had FU-DWI (+) lesions in 36 hemispheres. In the multivariable analysis, ASL defects remained an independent predictor of FU-DWI (+) (adjusted odds ratio, 13.94 [95% CI, 5.77-33.70],