Cerase A, Lazzeretti L, Vallone I M, Ferretti F, Bracco S, Galluzzi P, Gennari P, Monti L, Menci E, Bellini M, Arrigucci U, Cioni S, Romano D, Sanna A, Zandonella A, Acampa M, Tassi R, Martini G, Venturi C
UOC NINT Neuroimmagini e Neurointerventistica, Dipartimento di Scienze Neurologiche e Neurosensoriali, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italia.
Minerva Med. 2012 Aug;103(4):299-311.
Transient ischemic attack (TIA) has to be considered an "alarm bell" of a more or less severe organic or systemic vasculopathy. Positive findings at neuroimaging means tissue damage. The purpose of this retrospective study was to assess the role of neuroimaging in the management of patients presenting with TIA, and to consider the relative implications.
In a consecutive series of 82 patients (53 males, 29 females, mean age: 65.9±13.1 years) admitted for TIA, it was possible to review the history and the clinical data of 66 patients, including ABCD2 score, laboratory including plasmatic D-dimer, and neuroimaging data including computed tomography (CT) and magnetic resonance imaging including diffusion-weighted with apparent diffusion coefficient measure (DWI-ADC) obtained at diagnosis and by a week later (16 by CT, and 50 by DWI-ADC). Thirty-three patients underwent DWI-ADC within 24 hours from symptoms onset. Statistical analysis has been performed by non-parametric tests (χ2 and Mann-Whitney), and logistic regression by a commercially available software.
CT and/or DWI-ADC showed signs of acute ischemic lesions in 23/66 (35%) patients. 12 out of the 35 patients with a 24-hour DWI-ADC follow-up were positive. Statistical analysis showed that positive neuroimaging was significantly associated only with familial history of cardiovascular diseases (P<0.012) and previous TIA/stroke (P<0.046).
In this patients series, at least 35% of patients with TIA had a positive neuroimaging, especially DWI-ADC. Positive neuroimaging seems an independent factor. Patients with TIA need an early assessment by neuroimaging including DWI-ADC, in order to obtain a correct classification and prognosis.
短暂性脑缺血发作（TIA）必须被视为或多或少严重的器质性或系统性血管病变的“警钟”。神经影像学检查的阳性结果意味着组织损伤。这项回顾性研究的目的是评估神经影像学在TIA患者管理中的作用，并考虑其相关影响。
在连续收治的82例TIA患者（53例男性，29例女性，平均年龄：65.9±13.1岁）中，对66例患者的病史和临床资料进行了回顾，包括ABCD2评分、实验室检查（包括血浆D-二聚体）以及神经影像学资料（包括计算机断层扫描（CT）和磁共振成像，包括诊断时及一周后获得的弥散加权成像及表观扩散系数测量（DWI-ADC））（16例进行CT检查，50例进行DWI-ADC检查）。33例患者在症状发作后24小时内接受了DWI-ADC检查。采用非参数检验（χ2检验和曼-惠特尼检验）进行统计分析，并使用商用软件进行逻辑回归分析。
CT和/或DWI-ADC显示23/66（35%）例患者有急性缺血性病变迹象。在35例接受24小时DWI-ADC随访的患者中，12例呈阳性。统计分析表明，神经影像学检查阳性仅与心血管疾病家族史（P<0.012）和既往TIA/中风（P<0.046）显著相关。
在该患者系列中至少35%的TIA患者神经影像学检查呈阳性，尤其是DWI-ADC检查。神经影像学检查阳性似乎是一个独立因素。TIA患者需要通过包括DWI-ADC在内的神经影像学检查进行早期评估，以便获得正确的分类和预后。
