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

Ki Woong Nam, Chi Kyung Kim, Sang Bae Ko, Byung Woo Yoon, Roh Eul Yoo, Chul Ho Sohn

Research output: Contribution to journalArticle

Abstract

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], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.

Original languageEnglish
Pages (from-to)186-192
Number of pages7
JournalStroke
Volume51
Issue number1
DOIs
Publication statusPublished - 2020 Jan 1

Fingerprint

Transient Ischemic Attack
Perfusion
Recurrence
Artifacts
Odds Ratio
Magnetic Resonance Imaging

Keywords

  • diffusion
  • magnetic resonance imaging
  • perfusion
  • prognosis
  • transient ischemic attack

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack. / Nam, Ki Woong; Kim, Chi Kyung; Ko, Sang Bae; Yoon, Byung Woo; Yoo, Roh Eul; Sohn, Chul Ho.

In: Stroke, Vol. 51, No. 1, 01.01.2020, p. 186-192.

Research output: Contribution to journalArticle

Nam, Ki Woong ; Kim, Chi Kyung ; Ko, Sang Bae ; Yoon, Byung Woo ; Yoo, Roh Eul ; Sohn, Chul Ho. / Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack. In: Stroke. 2020 ; Vol. 51, No. 1. pp. 186-192.
@article{695a9feb68704b95a9124c52320aae78,
title = "Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack",
abstract = "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], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6{\%}) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95{\%} CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.",
keywords = "diffusion, magnetic resonance imaging, perfusion, prognosis, transient ischemic attack",
author = "Nam, {Ki Woong} and Kim, {Chi Kyung} and Ko, {Sang Bae} and Yoon, {Byung Woo} and Yoo, {Roh Eul} and Sohn, {Chul Ho}",
year = "2020",
month = "1",
day = "1",
doi = "10.1161/STROKEAHA.119.026556",
language = "English",
volume = "51",
pages = "186--192",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack

AU - Nam, Ki Woong

AU - Kim, Chi Kyung

AU - Ko, Sang Bae

AU - Yoon, Byung Woo

AU - Yoo, Roh Eul

AU - Sohn, Chul Ho

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.

AB - 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], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.

KW - diffusion

KW - magnetic resonance imaging

KW - perfusion

KW - prognosis

KW - transient ischemic attack

UR - http://www.scopus.com/inward/record.url?scp=85077225625&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077225625&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.119.026556

DO - 10.1161/STROKEAHA.119.026556

M3 - Article

C2 - 31718505

AN - SCOPUS:85077225625

VL - 51

SP - 186

EP - 192

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 1

ER -