Significance of arterial spin labeling perfusion and susceptibility weighted imaging changes in patients with transient ischemic attack: a prospective cohort study

TY - JOUR

T1 - Significance of arterial spin labeling perfusion and susceptibility weighted imaging changes in patients with transient ischemic attack

T2 - a prospective cohort study

AU - Havsteen, Inger

AU - Willer, Lasse

AU - Ovesen, Christian

AU - Nybing, Janus Damm

AU - Ægidius, Karen

AU - Marstrand, Jacob

AU - Meden, Per

AU - Rosenbaum, Sverre

AU - Folke, Marie Norsker

AU - Christensen, Hanne

AU - Christensen, Anders

PY - 2018/8/20

Y1 - 2018/8/20

N2 - Background: In a prospective cohort of patients with transient ischemic attack (TIA), we investigated usefulness and feasibility of arterial spin labeling (ASL) perfusion and susceptibility weighted imaging (SWI) alone and in combination with standard diffusion weighted (DWI) imaging in subacute diagnostic work-up. We investigated rates of ASL and SWI changes and their potential correlation to lasting infarction 8weeks after ictus. Methods: Patients with TIA underwent 3T-MRI including DWI, ASL and SWI within 72h of symptom onset. We defined lasting infarction as presence of 8-week MRI T2-fluid attenuated inversion recovery (FLAIR) hyperintensity or atrophy in the area of initial DWI-lesion. Results: We included 116 patients. Diffusion and perfusion together identified more patients with ischemia than either alone (59% vs. 40%, p<0.0001). The presence of both diffusion and perfusion lesions had the highest rate of 8-week gliosis scars, 65% (p<0.0001). In white matter, DWI-restriction was the determinant factor for scar development. However, in cortical gray matter half of lesions with perfusion deficit left a scar, while lesions without perfusion change rarely resulted in scars (56% versus 21%, p=0.03). SWI lesions were rare (6%) and a subset of perfusion lesions. SWI-lesions with DWI-lesions were all located in cortical gray matter and showed high scar rate. Conclusions: ASL perfusion increased ischemia detection in patients with TIA, and was most useful in conjunction with DWI. ASL was fast, robust and useful in a subacute clinical diagnostic setting. SWI had few positive findings and did not add information.

AB - Background: In a prospective cohort of patients with transient ischemic attack (TIA), we investigated usefulness and feasibility of arterial spin labeling (ASL) perfusion and susceptibility weighted imaging (SWI) alone and in combination with standard diffusion weighted (DWI) imaging in subacute diagnostic work-up. We investigated rates of ASL and SWI changes and their potential correlation to lasting infarction 8weeks after ictus. Methods: Patients with TIA underwent 3T-MRI including DWI, ASL and SWI within 72h of symptom onset. We defined lasting infarction as presence of 8-week MRI T2-fluid attenuated inversion recovery (FLAIR) hyperintensity or atrophy in the area of initial DWI-lesion. Results: We included 116 patients. Diffusion and perfusion together identified more patients with ischemia than either alone (59% vs. 40%, p<0.0001). The presence of both diffusion and perfusion lesions had the highest rate of 8-week gliosis scars, 65% (p<0.0001). In white matter, DWI-restriction was the determinant factor for scar development. However, in cortical gray matter half of lesions with perfusion deficit left a scar, while lesions without perfusion change rarely resulted in scars (56% versus 21%, p=0.03). SWI lesions were rare (6%) and a subset of perfusion lesions. SWI-lesions with DWI-lesions were all located in cortical gray matter and showed high scar rate. Conclusions: ASL perfusion increased ischemia detection in patients with TIA, and was most useful in conjunction with DWI. ASL was fast, robust and useful in a subacute clinical diagnostic setting. SWI had few positive findings and did not add information.

KW - Aged

KW - Diffusion Magnetic Resonance Imaging/methods

KW - Feasibility Studies

KW - Female

KW - Humans

KW - Ischemic Attack, Transient/diagnostic imaging

KW - Male

KW - Middle Aged

KW - Perfusion Imaging/methods

KW - Prospective Studies

KW - Spin Labels

KW - White Matter/diagnostic imaging

U2 - 10.1186/s12880-018-0264-6

DO - 10.1186/s12880-018-0264-6

M3 - Journal article

C2 - 30126352

SN - 1471-2342

VL - 18

SP - 1

EP - 8

JO - BMC Medical Imaging

JF - BMC Medical Imaging

IS - 1

M1 - 24

ER -