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Published in: Neuroradiology 4/2013

01-04-2013 | Diagnostic Neuroradiology

Frequency of emerging positive diffusion-weighted imaging in early repeat examinations at least 24 h after transient ischemic attacks

Authors: Naomi Morita, Masafumi Harada, Junichiro Satomi, Yuka Terasawa, Ryuji Kaji, Shinji Nagahiro

Published in: Neuroradiology | Issue 4/2013

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Abstract

Introduction

The relationships between diffusion lesions and risk scores for patients with a Transient ischemic attack (TIA) and the optimal timing for diffusion lesion screening have not been characterized. The purpose of our study was to evaluate the appearance of diffusion-weighted imaging (DWI) lesions during follow-up examinations of patients with TIA or minor stroke without initial DWI lesions.

Methods

We identified 31 patients who did not show diffusion lesions in initial DWI. A second magnetic resonance imaging (MRI) examination was performed 24 h after the initial MRI, and the patients were divided into two groups based on the results. Demographic and clinical data, including initial National Institutes of Health Stroke Scale scores, ABCD and ABCD2 scores, and other MRI findings were evaluated. The data were analyzed using Spearman’s rank tests and unpaired t tests.

Results

Ten patients (32.3 %) showed diffusion lesions on the second DWI examination. Both risk scores were higher in these patients compared with patients with negative results on follow-up DWI (P < 0.05, unpaired t test) and correlated with the length of the TIA (R s = 0.017, P < 0.05; R s = 0.003, P < 0.01; Spearman’s rank test).

Conclusion

Our results suggest that TIA patients with high-risk scores might be underestimated if the first MRI was performed within 24 h of symptom onset.
Literature
1.
go back to reference Special report from the National Institute of Neurological Disorders and Stroke (1990) Classification of cerebrovascular diseases III. Stroke 21:637–676CrossRef Special report from the National Institute of Neurological Disorders and Stroke (1990) Classification of cerebrovascular diseases III. Stroke 21:637–676CrossRef
2.
go back to reference Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, Sherman DG, TIA Working Group (2002) Transient ischemic attack—proposal for a new definition. N Engl J Med 347:1713–1716PubMedCrossRef Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, Sherman DG, TIA Working Group (2002) Transient ischemic attack—proposal for a new definition. N Engl J Med 347:1713–1716PubMedCrossRef
3.
go back to reference Johnston SC, Gress DR, Browner WS, Sidney S (2000) Short-term prognosis after emergency department diagnosis of TIA. JAMA 284:2901–2906PubMedCrossRef Johnston SC, Gress DR, Browner WS, Sidney S (2000) Short-term prognosis after emergency department diagnosis of TIA. JAMA 284:2901–2906PubMedCrossRef
4.
go back to reference Inatomi Y, Kimura K, Yonehara T, Fujioka S, Uchino M (2004) DWI abnormalities and clinical characteristics in TIA patients. Neurology 62:376–380PubMedCrossRef Inatomi Y, Kimura K, Yonehara T, Fujioka S, Uchino M (2004) DWI abnormalities and clinical characteristics in TIA patients. Neurology 62:376–380PubMedCrossRef
5.
go back to reference Kidwell CS, Alger JR, Di Salle F, Starkman S, Villablanca P, Bentson J, Saver JL (1999) Diffusion MRI in patients with transient ischemic attacks. Stroke 30:1174–1180PubMedCrossRef Kidwell CS, Alger JR, Di Salle F, Starkman S, Villablanca P, Bentson J, Saver JL (1999) Diffusion MRI in patients with transient ischemic attacks. Stroke 30:1174–1180PubMedCrossRef
6.
go back to reference Engelter ST, Provenzale JM, Petrella JR, Alberts MJ (1999) Diffusion MR imaging and transient ischemic attacks. Stroke 30:2762–2763PubMedCrossRef Engelter ST, Provenzale JM, Petrella JR, Alberts MJ (1999) Diffusion MR imaging and transient ischemic attacks. Stroke 30:2762–2763PubMedCrossRef
7.
go back to reference Ay H, Oliveira-Filho J, Buonanno FS, Schaefer PW, Furie KL, Chang YC, RordorfG SLH, Gonzalez RG, Koroshetz WJ (2002) ‘Footprints’ of transient ischemic attacks: a diffusion-weighted MRI study. Cerebrovasc Dis 14:177–186PubMedCrossRef Ay H, Oliveira-Filho J, Buonanno FS, Schaefer PW, Furie KL, Chang YC, RordorfG SLH, Gonzalez RG, Koroshetz WJ (2002) ‘Footprints’ of transient ischemic attacks: a diffusion-weighted MRI study. Cerebrovasc Dis 14:177–186PubMedCrossRef
8.
go back to reference Rovira A, Rovira-Gols A, Pedraza S, Grivé E, Molina C, Alvarez-Sabín J (2002) Diffusion-weighted MR imaging in the acute phase of transient ischemic attacks. AJNR Am J Neuroradiol 23:77–83PubMed Rovira A, Rovira-Gols A, Pedraza S, Grivé E, Molina C, Alvarez-Sabín J (2002) Diffusion-weighted MR imaging in the acute phase of transient ischemic attacks. AJNR Am J Neuroradiol 23:77–83PubMed
9.
go back to reference Kamal AK, Segal AZ, Uluğ AM (2002) Quantitative diffusion-weighted MR imaging intransient ischemic attacks. AJNR Am J Neuroradiol 23:1533–1538PubMed Kamal AK, Segal AZ, Uluğ AM (2002) Quantitative diffusion-weighted MR imaging intransient ischemic attacks. AJNR Am J Neuroradiol 23:1533–1538PubMed
10.
go back to reference Purroy F, Montaner J, Rovira A, Delgado P, Quintana M, Alvarez-Sabín J (2004) Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions. Stroke 35:2313–2319PubMedCrossRef Purroy F, Montaner J, Rovira A, Delgado P, Quintana M, Alvarez-Sabín J (2004) Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions. Stroke 35:2313–2319PubMedCrossRef
11.
go back to reference Crisostomo RA, Garcia MM, Tong DC (2003) Detection of diffusion-weighted MRI abnormalities in patients with transient ischemic attack: correlation with clinical characteristics. Stroke 34:932–937PubMedCrossRef Crisostomo RA, Garcia MM, Tong DC (2003) Detection of diffusion-weighted MRI abnormalities in patients with transient ischemic attack: correlation with clinical characteristics. Stroke 34:932–937PubMedCrossRef
12.
go back to reference Winbeck K, Bruckmaier K, Etgen T, von Einsiedel HG, Röttinger M, Sander D (2004) Transient ischemic attack and stroke can be differentiated by analyzing early diffusion-weighted imaging signal intensity changes. Stroke 35:1095–1099PubMedCrossRef Winbeck K, Bruckmaier K, Etgen T, von Einsiedel HG, Röttinger M, Sander D (2004) Transient ischemic attack and stroke can be differentiated by analyzing early diffusion-weighted imaging signal intensity changes. Stroke 35:1095–1099PubMedCrossRef
13.
go back to reference Schulz UG, Briley D, Meagher T, Molyneux A, Rothwell PM (2004) Diffusion-weighted MRI in 300 patients presenting late with subacute transient ischemic attack or minor stroke. Stroke 35:2459–2465PubMedCrossRef Schulz UG, Briley D, Meagher T, Molyneux A, Rothwell PM (2004) Diffusion-weighted MRI in 300 patients presenting late with subacute transient ischemic attack or minor stroke. Stroke 35:2459–2465PubMedCrossRef
14.
go back to reference Marx JJ, Mika-Gruettner A, Thoemke F, Fitzek S, Fitzek C, Vucurevic G, Urban PP, Stoeter P, Hopf HC (2002) Diffusion weighted magnetic resonance imaging in the diagnosis of reversible ischaemic deficits of the brainstem. J Neurol Neurosurg Psychiatry 72:572–575PubMedCrossRef Marx JJ, Mika-Gruettner A, Thoemke F, Fitzek S, Fitzek C, Vucurevic G, Urban PP, Stoeter P, Hopf HC (2002) Diffusion weighted magnetic resonance imaging in the diagnosis of reversible ischaemic deficits of the brainstem. J Neurol Neurosurg Psychiatry 72:572–575PubMedCrossRef
15.
go back to reference Restrepo L, Jacobs MA, Barker PB, Wityk RJ (2004) Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging. AJNR Am J Neuroradiol 25:1645–1652PubMed Restrepo L, Jacobs MA, Barker PB, Wityk RJ (2004) Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging. AJNR Am J Neuroradiol 25:1645–1652PubMed
16.
go back to reference Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z (2005) A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 366:29–36PubMedCrossRef Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z (2005) A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 366:29–36PubMedCrossRef
17.
go back to reference Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S (2007) Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 369:283–292PubMedCrossRef Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S (2007) Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 369:283–292PubMedCrossRef
18.
go back to reference Amarenco P, Labreuche J, Lavallée PC, Meseguer E, Cabrejo L, Slaoui T, Guidoux C, Olivot JM, Abboud H, Lapergue B, Klein IF, Mazighi M, Touboul PJ (2009) Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack. Stroke 40:3091–3095PubMedCrossRef Amarenco P, Labreuche J, Lavallée PC, Meseguer E, Cabrejo L, Slaoui T, Guidoux C, Olivot JM, Abboud H, Lapergue B, Klein IF, Mazighi M, Touboul PJ (2009) Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack. Stroke 40:3091–3095PubMedCrossRef
19.
go back to reference Josephson SA, Sidney S, Pham TN, Bernstein AL, Johnston SC (2008) Higher ABCD2 score predicts patients most likely to have true transient ischemic attack. Stroke 39:3096–3098PubMedCrossRef Josephson SA, Sidney S, Pham TN, Bernstein AL, Johnston SC (2008) Higher ABCD2 score predicts patients most likely to have true transient ischemic attack. Stroke 39:3096–3098PubMedCrossRef
20.
go back to reference Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE (2006) Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack. Stroke 37:1710–1714PubMedCrossRef Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE (2006) Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack. Stroke 37:1710–1714PubMedCrossRef
21.
go back to reference Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L, Setó E, Gil MI (2009) The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients. Stroke 40:2229–2232PubMedCrossRef Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L, Setó E, Gil MI (2009) The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients. Stroke 40:2229–2232PubMedCrossRef
22.
go back to reference Calvet D, Touzé E, Oppenheim C, Turc G, Meder JF, Mas JL (2009) DWI lesions and TIA etiology improve the prediction of stroke after TIA. Stroke 40:187–192PubMedCrossRef Calvet D, Touzé E, Oppenheim C, Turc G, Meder JF, Mas JL (2009) DWI lesions and TIA etiology improve the prediction of stroke after TIA. Stroke 40:187–192PubMedCrossRef
23.
go back to reference Coutts SB, Eliasziw M, Hill MD, Scott JN, Subramaniam S, Buchan AM, Demchuk AM, VISION study group (2008) An improved scoring system for identifying patients at high early risk of stroke and functional impairment after an acute transient ischemic attack or minor stroke. Int J Stroke 3:3–10PubMedCrossRef Coutts SB, Eliasziw M, Hill MD, Scott JN, Subramaniam S, Buchan AM, Demchuk AM, VISION study group (2008) An improved scoring system for identifying patients at high early risk of stroke and functional impairment after an acute transient ischemic attack or minor stroke. Int J Stroke 3:3–10PubMedCrossRef
24.
go back to reference Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM, VISION Study Group (2008) When to expect negative diffusion-weighted images in stroke and transient ischemic attack. Stroke 39:1898–1900PubMedCrossRef Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM, VISION Study Group (2008) When to expect negative diffusion-weighted images in stroke and transient ischemic attack. Stroke 39:1898–1900PubMedCrossRef
25.
go back to reference Oppenheim C, Lamy C, Touzé E, Calvet D, Hamon M, Mas JL, Méder JF (2006) Do transient ischemic attacks with diffusion-weighted imaging abnormalities correspond to brain infarctions? AJNR Am J Neuroradiol 27:1782–1787PubMed Oppenheim C, Lamy C, Touzé E, Calvet D, Hamon M, Mas JL, Méder JF (2006) Do transient ischemic attacks with diffusion-weighted imaging abnormalities correspond to brain infarctions? AJNR Am J Neuroradiol 27:1782–1787PubMed
26.
go back to reference Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, Lutsep HL, Miller E, Sacco RL, American Heart Association; American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Interdisciplinary Council on Peripheral Vascular Disease (2009) Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 40:2276–2293PubMedCrossRef Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, Lutsep HL, Miller E, Sacco RL, American Heart Association; American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Interdisciplinary Council on Peripheral Vascular Disease (2009) Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 40:2276–2293PubMedCrossRef
27.
go back to reference Toi H, Uno M, Harada M, Yoneda K, Morita N, Matsubara S, Satoh K, Nagahiro S (2003) Diagnosis of acute brain-stem infarcts using diffusion-weighed MRI. Neuroradiology 45:352–356PubMedCrossRef Toi H, Uno M, Harada M, Yoneda K, Morita N, Matsubara S, Satoh K, Nagahiro S (2003) Diagnosis of acute brain-stem infarcts using diffusion-weighed MRI. Neuroradiology 45:352–356PubMedCrossRef
28.
go back to reference Bertrand A, Oppenheim C, Lamy C, Rodrigo S, Naggara O, Mas JL, Meder JF (2008) Comparison of optimized and standard diffusion-weighted imaging at 1.5T for the detection of acute lesions in patients with transient ischemic attack. AJNR Am J Neuroradiol 29:363–365PubMedCrossRef Bertrand A, Oppenheim C, Lamy C, Rodrigo S, Naggara O, Mas JL, Meder JF (2008) Comparison of optimized and standard diffusion-weighted imaging at 1.5T for the detection of acute lesions in patients with transient ischemic attack. AJNR Am J Neuroradiol 29:363–365PubMedCrossRef
Metadata
Title
Frequency of emerging positive diffusion-weighted imaging in early repeat examinations at least 24 h after transient ischemic attacks
Authors
Naomi Morita
Masafumi Harada
Junichiro Satomi
Yuka Terasawa
Ryuji Kaji
Shinji Nagahiro
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 4/2013
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-012-1113-x

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