Published Online
on September 16, 2004

A more recent version of this article appeared on November 1, 2004

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Submitted on February 18, 2004
Revised on July 26, 2004
Accepted on August 3, 2004

Diffusion-Weighted MRI in 300 Patients Presenting Late With Subacute Transient Ischemic Attack or Minor Stroke

Ursula G. Schulz MD; Dennis Briley MD; Tom Meagher MD; Andrew Molyneux PhD; and Peter M. Rothwell PhD^*

From the Stroke Prevention Research Unit (U.G.S., P.M.R.), Department of Clinical Neurology and the Department of Neuroradiology (A.M.), Radcliffe Infirmary, Oxford, UK; and the Departments of Neurology (D.B.) and Radiology (T.M.), Stoke Mandeville Hospital NHS Trust, Aylesbury, UK.

^* To whom correspondence should be addressed. E-mail: peter.rothwell{at}clneuro.ox.ac.uk.

Background and Purpose--Many patients with transient ischemic attack (TIA) or minor stroke present to medical attention after a delay of several days or weeks, at which time it may be more difficult to obtain a clear history and clinical signs may have resolved. Because ischemic lesions on diffusion-weighted MRI (DWI) often persist for several weeks, we hypothesized that adding DWI to a standard protocol with T2-weighted imaging might be useful in the management of patients presenting late.

Methods--We studied consecutive patients with TIA or minor stroke presenting 3 days after the event. Two independent observers recorded the presence or absence of recent ischemic lesions on 2 different occasions, first with the T2 scan only, and second with T2 and DWI. Each time, with the aid of a written clinical summary, the observers recorded their diagnosis and proposed management.

Results--300 patients (159 men) were scanned at a median of 17 (interquartile range=10 to 23) days after symptom onset. DWI showed a high signal lesion in 114/164 (70%) minor strokes versus 17/136 (13%) TIAs (P<0.0001). The presence of high-signal lesions on DWI decreased nonlinearly with time since symptom onset (P<0.0001) and increased with National Institutes of Health Stroke Score (P=0.038) and with age (P=0.01). In 90/206 (43.7%) patients with 1 or multiple lesions on T2, DWI helped to clarify whether these were related to a recent ischemic event (79 [48%] strokes; 11 [31%] TIAs). Compared with T2 alone, DWI provided additional information in 108 (36%) patients (91 [56%] strokes and 17 [13%] TIAs), such as clarification of clinical diagnosis (18 patients, 6%) or vascular territory (28 patients, 9.3%), which was considered likely to influence management in 42 (14%) patients (32 [19%] strokes; 10 [7.4%] TIAs).

Conclusions--The clinically useful information available from DWI provides a further justification for an MRI-based imaging protocol in patients with subacute TIA or minor stroke.

Key words: epidemiology • magnetic resonance imaging • stroke • transient ischemic attack

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