Diffusion MRI in patients with transient ischemic attacks
Diffusion MRI in patients with transient ischemic attacks
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DOI：
10.1161/01.str.30.6.1174
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发表时间：
1999-06-01
期刊：
影响因子：
8.3
通讯作者：
Saver, JL
中科院分区：
文献类型：
--
作者：
Kidwell, CS;Alger, JR;Saver, JL
背景和目的--弥散磁共振成像在缺血性卒中患者中的应用价值已经确立，但在短暂性脑缺血发作(TLA)患者中尚未得到系统的研究。方法：收集连续42例有脑TIA症状的患者的临床、常规MRT和扩散MRI资料，并与同期23例完全性卒中患者的TLA成像数据进行比较。结果-42例TIA患者中，有20例(48%)在弥散加权成像(DWI)和表观扩散系数(ADC)成像上显示了神经解剖学相关的局灶性异常。与完全性卒中患者相比，TLA患者的DWI/ADC信号改变不明显且体积较小，DWI阳性患者的TIA症状持续时间显著长于DWI阴性患者的7.3h和3.2h。在超过三分之一的弥散MRI异常患者中，弥散MRI信息改变了疑似解剖和血管TIA的定位和疑似病因机制。在20例TIA患者中，有9例患者在弥散磁共振成像上发现了病变，其中9例患者进行了随访，其中4例患者在随诊时未发现相应的梗塞。结论扩散磁共振成像显示近一半临床明确的TIA患者存在缺血性异常，有弥散加权成像病变的患者的百分比随总症状持续时间的增加而增加，其中近一半患者的弥散成像病变可能是完全可逆的，而在其余的患者中，弥散磁共振成像的结果预示着尽管有短暂的临床症状，但仍有实质性脑梗塞的发生。最后，弥散成像结果具有重要的临床应用价值，经常改变假定的定位和发病机制。
Background and Purpose-Diffusion MRT has established value in patients with ischemic stroke but has not been systematically investigated in patients with transient ischemic attack (TLA),Methods-Clinical, conventional MRT, and diffusion MRI data were collected on 42 consecutive patients with symptoms of cerebral TIA, TLA 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 TLA 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 MRT, 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.