Abstract WP229: Clinical Significance Of Fluid-attenuated Inversion Recovery Vascular Hyperintensities In Transient Ischemic Attack
BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery vascular hyperintensities (FVH) is often seen in patients with acute ischemic stroke attributable to arterial stenosis or occlusion. However, clinical significance of FVH in patients with transient ischemic attack (TIA) remains understudied.
METHODS: Consecutive patients with TIA who underwent brain MRI within 24 hours of onset were studied. The frequency, relative factors, and time course of FVH were determined. Large artery atherosclerosis (LAA) was defined as more than 50 % stenosis or occlusion of the cervicocranial artery presumably due to atherosclerosis.
RESULTS: Of 202 patients enrolled (76 women, 69.0±13.2 years old, median onset-to-arrival time 98 min [IQR 60-200], none undergoing thrombolysis), FVH was identified in 41 (20%). Atrial fibrillation (AF, 49% vs. 19%, P<0.001), LAA (56% vs. 25%, P<0.001), and positive findings on diffusion weighted image were more common (32% vs. 14%, P=0.020) in FVH-positive patients than in FVH-negative patients. Multivariate analysis showed that AF (OR 7.50 ; 95% CI 2.85-16.8) and LAA (OR 6.60; 95% CI 3.18-16.8) were independently associated with FVH. Within 90 days after the onset, 13 patients developed recurrent TIA or ischemic stroke (17% in FVH-positive vs. 4% in FVH-negative, P=0.010); 9 did within a week, 1 did between 2-4 weeks, and 3 did later. After multivariate analysis, LAA was independently associated (OR 6.38; 95% CI 1.59-33.0) and FVH tended to be associated (OR 3.30; 95% CI 0.89-12.6) with the recurrent episode. Of 36 recurrence-free FVH-positive patients, 23 underwent follow-up MRI median 7 days (IQR 6-11) after onset. FVH was no longer positive in 15 patients (65%). In these 15 patients, AF was more common (67% vs 13%, P=0.027) and LAA was less common (13% vs 88%, P=0.001) than the other 8 patients with persistent FVH.
CONCLUSION: FVH was identified in 20% of acute TIA patients. AF and LAA were positively associated with FVH; AF seems to be associated with transient FVH and LAA does with persistent FVH.
- © 2012 by American Heart Association, Inc.