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BMC Medical Imaging
Published in: BMC Medical Imaging 1/2018

Open Access 01-12-2018 | Research article

Significance of arterial spin labeling perfusion and susceptibility weighted imaging changes in patients with transient ischemic attack: a prospective cohort study

Authors: Inger Havsteen, Lasse Willer, Christian Ovesen, Janus Damm Nybing, Karen Ægidius, Jacob Marstrand, Per Meden, Sverre Rosenbaum, Marie Norsker Folke, Hanne Christensen, Anders Christensen

Published in: BMC Medical Imaging | Issue 1/2018

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Abstract

Background

In a prospective cohort of patients with transient ischemic attack (TIA), we investigated usefulness and feasibility of arterial spin labeling (ASL) perfusion and susceptibility weighted imaging (SWI) alone and in combination with standard diffusion weighted (DWI) imaging in subacute diagnostic work-up. We investigated rates of ASL and SWI changes and their potential correlation to lasting infarction 8 weeks after ictus.

Methods

Patients with TIA underwent 3T-MRI including DWI, ASL and SWI within 72 h of symptom onset. We defined lasting infarction as presence of 8-week MRI T2-fluid attenuated inversion recovery (FLAIR) hyperintensity or atrophy in the area of initial DWI-lesion.

Results

We included 116 patients. Diffusion and perfusion together identified more patients with ischemia than either alone (59% vs. 40%, p < 0.0001). The presence of both diffusion and perfusion lesions had the highest rate of 8-week gliosis scars, 65% (p < 0.0001). In white matter, DWI-restriction was the determinant factor for scar development. However, in cortical gray matter half of lesions with perfusion deficit left a scar, while lesions without perfusion change rarely resulted in scars (56% versus 21%, p = 0.03). SWI lesions were rare (6%) and a subset of perfusion lesions. SWI-lesions with DWI-lesions were all located in cortical gray matter and showed high scar rate.

Conclusions

ASL perfusion increased ischemia detection in patients with TIA, and was most useful in conjunction with DWI. ASL was fast, robust and useful in a subacute clinical diagnostic setting. SWI had few positive findings and did not add information.

Trial Registration.

http://​www.​clinicaltrials.​gov. Unique Identifier NCT01531946, prospectively registered February 9, 2012.
Appendix
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Metadata
Title
Significance of arterial spin labeling perfusion and susceptibility weighted imaging changes in patients with transient ischemic attack: a prospective cohort study
Authors
Inger Havsteen
Lasse Willer
Christian Ovesen
Janus Damm Nybing
Karen Ægidius
Jacob Marstrand
Per Meden
Sverre Rosenbaum
Marie Norsker Folke
Hanne Christensen
Anders Christensen
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2018
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-018-0264-6

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