Jun Lee1, Manabu Inoue1, Michael Mlynash1, Sharanpal K Mann1, Carlo W Cereda1, Michael Ke1, Gregory W Albers1, Jean M Olivot2. 1. From Yeungnam University Medical Center (J.L.), Daegu, South Korea; Department of Vascular Medicine (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Stanford Stroke Center (M.M., G.W.A.), Stanford University, CA; Division of Neurology (S.K.M.), University of British Columbia, Vancouver, Canada; Stroke Center Neurocenter of Southern Switzerland (C.W.C.), Ospedale Civico, Switzerland; California Pacific Medical Center (M.K.), San Francisco; and Toulouse Neuroimaging Center UMR 1214 (J.M.O.), Stroke Unit, Toulouse University Hospital, France. 2. From Yeungnam University Medical Center (J.L.), Daegu, South Korea; Department of Vascular Medicine (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Stanford Stroke Center (M.M., G.W.A.), Stanford University, CA; Division of Neurology (S.K.M.), University of British Columbia, Vancouver, Canada; Stroke Center Neurocenter of Southern Switzerland (C.W.C.), Ospedale Civico, Switzerland; California Pacific Medical Center (M.K.), San Francisco; and Toulouse Neuroimaging Center UMR 1214 (J.M.O.), Stroke Unit, Toulouse University Hospital, France. jmolivot@gmail.com.
Abstract
OBJECTIVE: To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week. METHODS: Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled. Investigators blinded to clinical information independently assessed the presence of acute ischemic lesions on baseline DWI/PWI and follow-up DWI and FLAIR. Baseline and follow-up MRIs were then compared to determine the occurrence and location of new infarctions. RESULTS: Sixty-four patients met the inclusion criteria. Median (IQR) ABCD2 score was 4 (3-5). Median delay from onset to baseline and follow-up MRI was 5 (2-10) hours and 6 (5-7) days, respectively. MRI revealed an acute ischemic lesion on DWI and/or PWI in 38 patients. Nine patients (14%) had a new infarction on follow-up MRI. Each had a PWI and 4 had a DWI lesion on baseline MRI. All new BIs except one were asymptomatic and in the same location as the acute PWI lesion. CONCLUSIONS: Our results showed that 30% of the acute focal PWI lesions detected after a TIA are associated with a new BI at 1 week. Those new BIs may result from the progression of the initial ischemic injury.
OBJECTIVE: To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week. METHODS: Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled. Investigators blinded to clinical information independently assessed the presence of acute ischemic lesions on baseline DWI/PWI and follow-up DWI and FLAIR. Baseline and follow-up MRIs were then compared to determine the occurrence and location of new infarctions. RESULTS: Sixty-four patients met the inclusion criteria. Median (IQR) ABCD2 score was 4 (3-5). Median delay from onset to baseline and follow-up MRI was 5 (2-10) hours and 6 (5-7) days, respectively. MRI revealed an acute ischemic lesion on DWI and/or PWI in 38 patients. Nine patients (14%) had a new infarction on follow-up MRI. Each had a PWI and 4 had a DWI lesion on baseline MRI. All new BIs except one were asymptomatic and in the same location as the acute PWI lesion. CONCLUSIONS: Our results showed that 30% of the acute focal PWI lesions detected after a TIA are associated with a new BI at 1 week. Those new BIs may result from the progression of the initial ischemic injury.