(Stroke. 1999;30:1174-1180.)
© 1999 American Heart Association, Inc.
Original Contributions |
Diffusion MRI in Patients With Transient Ischemic Attacks
From the University of California at Los Angeles (UCLA) Stroke Center (C.S.K., J.R.A., S.S., P.V., J.B., J.L.S.); the Departments of Neurology (C.S.K., S.S., J.L.S.), Radiological Sciences (J.R.A., P.V., J.B.), and Emergency Medicine (S.S.); and the UCLA Brain Research Institute, UCLA Medical Center, Los Angeles, Calif; and the Department of Radiology, First Medical Faculty, University of Naples, Italy (F. Di S.).
Correspondence to Chelsea S. Kidwell, MD, Department of Neurology, Reed Neurologic Research Center, 710 Westwood Plaza, UCLA Medical Center, Los Angeles, CA 90095. E-mail ckidwell{at}ucla.edu
Background and Purpose—Diffusion MRI has established value in patients with ischemic stroke but has not been systematically investigated in patients with transient ischemic attack (TIA).
Methods—Clinical, conventional MRI, and diffusion MRI data were collected on 42 consecutive patients with symptoms of cerebral TIA. TIA imaging data were compared with those from a contemporaneous group of 23 completed stroke patients.
Results—Twenty of the 42 TIA patients (48%) demonstrated neuroanatomically relevant focal abnormalities on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) imaging. When present, DWI/ADC signal changes in TIA patients were less pronounced and smaller in volume than those in completed stroke patients. TIA symptom duration was significantly longer for DWI-positive than for DWI-negative patients, 7.3 versus 3.2 hours. Diffusion MRI information changed the suspected anatomic and vascular TIA localization and the suspected etiologic mechanism in over one third of patients with diffusion MRI abnormalities. Of the 20 TIA patients with identifiable lesions on diffusion MRI, 9 had follow-up imaging studies; of these, 4 did not show a relevant infarct on follow-up imaging.
Conclusions—Diffusion MRI demonstrates ischemic abnormalities in nearly half of clinically defined TIA patients. The percentage of patients with a DWI lesion increases with increasing total symptom duration. In nearly half, the diffusion MRI changes may be fully reversible, while in the remainder the diffusion MRI findings herald the development of a parenchymal infarct despite transient clinical symptoms. Finally, diffusion imaging results have significant clinical utility, frequently changing the presumed localization and etiologic mechanism.
Key Words: cerebral ischemia, transient • magnetic resonance imaging • magnetic resonance imaging, diffusion-weighted
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J.B. Fiebach, P.D. Schellinger, O. Jansen, M. Meyer, P. Wilde, J. Bender, P. Schramm, E. Juttler, J. Oehler, M. Hartmann, et al. CT and Diffusion-Weighted MR Imaging in Randomized Order: Diffusion-Weighted Imaging Results in Higher Accuracy and Lower Interrater Variability in the Diagnosis of Hyperacute Ischemic Stroke Stroke, September 1, 2002; 33(9): 2206 - 2210. [Abstract] [Full Text] [PDF]
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M. E. Mullins, P. W. Schaefer, A. G. Sorensen, E. F. Halpern, H. Ay, J. He, W. J. Koroshetz, and R. G. Gonzalez CT and Conventional and Diffusion-weighted MR Imaging in Acute Stroke: Study in 691 Patients at Presentation to the Emergency Department Radiology, August 1, 2002; 224(2): 353 - 360. [Abstract] [Full Text] [PDF]
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M. E. Mullins, M. H. Lev, D. Schellingerhout, W. J. Koroshetz, and R. G. Gonzalez Influence of Availability of Clinical History on Detection of Early Stroke Using Unenhanced CT and Diffusion-Weighted MR Imaging Am. J. Roentgenol., July 1, 2002; 179(1): 223 - 228. [Abstract] [Full Text] [PDF]
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J J Marx, A Mika-Gruettner, F Thoemke, S Fitzek, C Fitzek, G Vucurevic, P P Urban, P Stoeter, and H C Hopf Diffusion weighted magnetic resonance imaging in the diagnosis of reversible ischaemic deficits of the brainstem J. Neurol. Neurosurg. Psychiatry, May 1, 2002; 72(5): 572 - 575. [Abstract] [Full Text] [PDF]
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G. H. Danton, R. Prado, B. D. Watson, and W. D. Dietrich Temporal Profile of Enhanced Vulnerability of the Postthrombotic Brain to Secondary Embolic Events Stroke, April 1, 2002; 33(4): 1113 - 1119. [Abstract] [Full Text] [PDF]
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H. J. Jaeger, K. D. Mathias, E. Hauth, R. Drescher, H. M. Gissler, S. Hennigs, and A. Christmann Cerebral Ischemia Detected with Diffusion-Weighted MR Imaging after Stent Implantation in the Carotid Artery AJNR Am. J. Neuroradiol., February 1, 2002; 23(2): 200 - 207. [Abstract] [Full Text] [PDF]
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J. L. Sunshine Transient Ischemic Attacks: Added Specificity from Modern MR Imaging AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 4 - 5. [Full Text] [PDF]
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A. Rovira, A. Rovira-Gols, S. Pedraza, E. Grive, C. Molina, and J. Alvarez-Sabin Diffusion-Weighted MR Imaging in the Acute Phase of Transient Ischemic Attacks AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 77 - 83. [Abstract] [Full Text] [PDF]
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R. H.C. Bisschops, L.J. Kappelle, W. P.T.M. Mali, and J. van der Grond Hemodynamic and Metabolic Changes in Transient Ischemic Attack Patients: A Magnetic Resonance Angiography and 1H-Magnetic Resonance Spectroscopy Study Performed Within 3 Days of Onset of a Transient Ischemic Attack Stroke, January 1, 2002; 33(1): 110 - 115. [Abstract] [Full Text] [PDF]
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P. E. Grant, J. He, E. F. Halpern, O. Wu, P. W. Schaefer, L. H. Schwamm, R. F. Budzik, A. G. Sorensen, W. J. Koroshetz, and R. G. Gonzalez Frequency and Clinical Context of Decreased Apparent Diffusion Coefficient Reversal in the Human Brain Radiology, October 1, 2001; 221(1): 43 - 50. [Abstract] [Full Text] [PDF]
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H. J. Jaeger, K. D. Mathias, R. Drescher, E. Hauth, G. Bockisch, E. Demirel, and H. Martin Gissler Diffusion-weighted MR Imaging After Angioplasty or Angioplasty Plus Stenting of Arteries Supplying the Brain AJNR Am. J. Neuroradiol., August 1, 2001; 22(7): 1251 - 1259. [Abstract] [Full Text] [PDF]
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S. Condette-Auliac, S. Bracard, R. Anxionnat, E. Schmitt, J. C. Lacour, M. Braun, J. Meloneto, A. Cordebar, L. Yin, and L. Picard Vasospasm After Subarachnoid Hemorrhage: Interest in Diffusion-Weighted MR Imaging Stroke, August 1, 2001; 32(8): 1818 - 1824. [Abstract] [Full Text] [PDF]
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K. Kimura, K. Minematsu, M. Koga, R. Arakawa, M. Yasaka, H. Yamagami, K. Nagatsuka, H. Naritomi, and T. Yamaguchi Microembolic Signals and Diffusion-weighted MR Imaging Abnormalities in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1037 - 1042. [Abstract] [Full Text] [PDF]
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K. P.N. Forbes, H. A. Shill, P. M. Britt, J. M. Zabramski, R. F. Spetzler, and J. E. Heiserman Assessment of Silent Embolism from Carotid Endarterectomy by Use of Diffusion-weighted Imaging: Work in Progress AJNR Am. J. Neuroradiol., April 1, 2001; 22(4): 650 - 653. [Abstract] [Full Text]
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R. von Kummer, H. Bourquain, S. Bastianello, L. Bozzao, C. Manelfe, D. Meier, and W. Hacke Early Prediction of Irreversible Brain Damage after Ischemic Stroke at CT Radiology, April 1, 2001; 219(1): 95 - 100. [Abstract] [Full Text]
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K. P.N. Forbes, J. G. Pipe, and J. E. Heiserman Evidence for Cytotoxic Edema in the Pathogenesis of Cerebral Venous Infarction AJNR Am. J. Neuroradiol., March 1, 2001; 22(3): 450 - 455. [Abstract] [Full Text]
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P. Pantano, D. Toni, F. Caramia, A. Falcou, M. Fiorelli, C. Argentino, L. M. Fantozzi, and L. Bozzao Relationship between Vascular Enhancement, Cerebral Hemodynamics, and MR Angiography in Cases of Acute Stroke AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 255 - 260. [Abstract] [Full Text] [PDF]
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W.-D. Heiss, L. W. Kracht, A. Thiel, M. Grond, and G. Pawlik Penumbral probability thresholds of cortical flumazenil binding and blood flow predicting tissue outcome in patients with cerebral ischaemia Brain, January 1, 2001; 124(1): 20 - 29. [Abstract] [Full Text] [PDF]
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P. W. Schaefer, P. E. Grant, and R. G. Gonzalez Diffusion-weighted MR Imaging of the Brain Radiology, November 1, 2000; 217(2): 331 - 345. [Abstract] [Full Text]
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K. Krueger, H. Kugel, M. Grond, A. Thiel, D. Maintz, and K. Lackner Late Resolution of Diffusion-Weighted MRI Changes in a Patient With Prolonged Reversible Ischemic Neurological Deficit After Thrombolytic Therapy Stroke, November 1, 2000; 31(11): 2715 - 2718. [Abstract] [Full Text] [PDF]
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S. L. Keir and J. M. Wardlaw Systematic Review of Diffusion and Perfusion Imaging in Acute Ischemic Stroke Stroke, November 1, 2000; 31(11): 2723 - 2731. [Abstract] [Full Text] [PDF]
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R. T.F. Cheung, M. Weih, and U. Dirnagl Ischemic Preconditioning and Tolerance in Human Brain Response Stroke, September 1, 2000; 31 (9): 2266 - 2278. [Full Text] [PDF]
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C. Oppenheim, R. Stanescu, D. Dormont, S. Crozier, B. Marro, Y. Samson, G. Rancurel, and C. Marsault False-negative Diffusion-weighted MR Findings in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., August 1, 2000; 21(8): 1434 - 1440. [Abstract] [Full Text]
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T. Neumann-Haefelin, A. Kastrup, A. de Crespigny, M. A. Yenari, T. Ringer, G. H. Sun, M. E. Moseley, and M. Fisher Serial MRI After Transient Focal Cerebral Ischemia in Rats : Dynamics of Tissue Injury, Blood-Brain Barrier Damage, and Edema Formation Editorial Comment: Dynamics of Tissue Injury, Blood-Brain Barrier Damage, and Edema Formation Stroke, August 1, 2000; 31(8): 1965 - 1973. [Abstract] [Full Text] [PDF]
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