A.A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital, Harvard Medical School, Charlestown MA 02129, USA.
Stroke. 2011 Aug;42(8):2186-90. doi: 10.1161/STROKEAHA.110.604280. Epub 2011 Jun 16.
The risk of stroke shortly after transient ischemic attack with infarction on diffusion-weighted images, also known as transient symptoms with infarction (TSI), is substantially higher than is the risk after imaging-normal transient ischemic attack. We sought to assess the utility of a Web-based recurrence risk estimator (RRE; http://www.nmr.mgh.harvard.edu/RRE/) originally developed for use in patients with ischemic stroke for predicting 7-day risk of stroke in patients with TSI.
We calculated RRE and ABCD² scores in a retrospective series of 257 consecutive patients with TSI diagnosed by diffusion-weighted images within 24 hours of symptom onset. We defined subsequent stroke as clinical deterioration associated with new infarction spatially distinct from the index lesion. We assessed the predictive performance of each model by computing the area under receiver-operating characteristics curve.
Over 7-day follow-up, 16 patients developed a recurrent stroke (6.2%). The sensitivity and specificity of an RRE score of ≥ 2 for predicting 7-day stroke risk were 87% and 73%, respectively. The area under the receiver-operating characteristics curve was 0.85 (95% CI, 0.78-0.92) for RRE and 0.57 (95% CI, 0.45-0.69) for ABCD² score (z-test; P<0.001).
The RRE score seems to predict 7-day risk of stroke after a TSI. If further validated in larger data sets, the RRE score could be useful in identifying high-risk patients with TSI who may benefit from early intervention with targeted stroke prevention strategies.
在扩散加权图像上显示有梗塞的短暂性脑缺血发作后发生卒中的风险（亦称伴有梗塞的短暂性症状 TSI），明显高于影像正常的短暂性脑缺血发作后发生卒中的风险。我们旨在评估最初为缺血性卒中患者开发的基于网络的复发风险估算器（RRE；http://www.nmr.mgh.harvard.edu/RRE/），在预测 TSI 患者 7 天内卒中风险方面的效用。
我们对在症状发作后 24 小时内通过扩散加权图像诊断为 TSI 的 257 例连续患者进行了 RRE 和 ABCD²评分的计算。我们将随后的卒中定义为与指数病灶空间不同的新梗塞相关的临床恶化。我们通过计算接受者操作特征曲线下面积来评估每个模型的预测性能。
在 7 天的随访期间，有 16 名患者发生了复发性卒中（6.2%）。RRE 评分≥2 预测 7 天内卒中风险的敏感性和特异性分别为 87%和 73%。RRE 的接受者操作特征曲线下面积为 0.85（95%CI，0.78-0.92），ABCD²评分的面积为 0.57（95%CI，0.45-0.69）（Z 检验；P<0.001）。
RRE 评分似乎可预测 TSI 后 7 天内的卒中风险。如果在更大的数据集上得到进一步验证，RRE 评分可能有助于识别 TSI 高危患者，这些患者可能受益于针对特定卒中预防策略的早期干预。
