Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e310-6. doi: 10.1016/j.jstrokecerebrovasdis.2012.12.007. Epub 2013 Jan 22.
This study investigated factors associated with the presence of acute ischemic lesions after transient ischemic attack (TIA), using diffusion-weighted imaging (DWI) data from a multicenter retrospective, observational study.
Of the 464 patients admitted to 13 stroke centers in Japan within 7 days after TIA onset, 458 patients underwent a DWI examination in this registry. Patients were divided into those with acute ischemic lesions and those without. We analyzed associations between DWI lesions and baseline characteristics, including age, sex, comorbidities, large artery atherosclerosis (LAA), type and duration of symptoms, the presence of multiple occurrences of TIA within 90 days before hospital visits (multiple TIAs) and the time from symptom onset to DWI examination (time-to-DWI).
Among the 458 patients (291 men, 68.4±13.2 years old), 374 (81.7%) underwent a DWI examination within the initial 24 hours after the symptom onset. DWI lesions were found in 96 patients (21.0%), and divided into a single lesion (56 patients, 12.2%) or multiple lesions (40 patients, 8.7%). The presence of DWI lesions had an association with male sex (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.07-3.29), time-to-DWI longer than 24 hours (OR 2.96; CI 1.57-5.52), and intracranial LAA (OR 1.99; CI 1.02-3.79). The presence of a single DWI lesion had an association with atrial fibrillation (OR 2.70; CI 1.41-5.03), and multiple DWI lesions did with time-to-DWI longer than 24 hours (OR 6.20; CI 2.60-15.20), multiple TIAs (OR 3.04; CI 1.35-6.76), intracranial LAA (OR 3.63; CI 1.44-8.89), and extracranial LAA (OR 3.53; CI 1.08-10.78).
Acute ischemic lesions on DWI were associated with time-to-DWI and LAA in patients with classically defined TIA. Additionally, we identified some differences in relating factors between patients with single and multiple DWI lesions. These results indicate that time-to-DWI and DWI lesion pattern may be important for the diagnosis and management of TIA.
本研究通过多中心回顾性观察研究的弥散加权成像（DWI）数据，调查了短暂性脑缺血发作（TIA）后出现急性缺血性病变的相关因素。
在 TIA 发作后 7 天内，464 例患者入住日本 13 家卒中中心，其中 458 例在本研究中进行了 DWI 检查。患者分为有急性缺血性病变组和无急性缺血性病变组。我们分析了 DWI 病变与基线特征之间的关系，包括年龄、性别、合并症、大动脉粥样硬化（LAA）、症状类型和持续时间、90 天内就诊前多次 TIA 发作（多次 TIA）的存在以及从症状发作到 DWI 检查的时间（至 DWI 时间）。
在 458 例患者（291 例男性，68.4±13.2 岁）中，374 例（81.7%）在症状发作后 24 小时内进行了 DWI 检查。96 例（21.0%）患者发现 DWI 病变，分为单发病变（56 例，12.2%）或多发病变（40 例，8.7%）。DWI 病变的存在与男性（比值比[OR]1.84；95%置信区间[CI]1.07-3.29）、至 DWI 时间超过 24 小时（OR 2.96；CI 1.57-5.52）和颅内 LAA（OR 1.99；CI 1.02-3.79）有关。单发 DWI 病变与心房颤动（OR 2.70；CI 1.41-5.03）有关，多发 DWI 病变与至 DWI 时间超过 24 小时（OR 6.20；CI 2.60-15.20）、多次 TIA（OR 3.04；CI 1.35-6.76）、颅内 LAA（OR 3.63；CI 1.44-8.89）和颅外 LAA（OR 3.53；CI 1.08-10.78）有关。
在经典定义的 TIA 患者中，DWI 上的急性缺血性病变与至 DWI 时间和 LAA 有关。此外，我们在单发和多发 DWI 病变患者之间发现了一些相关因素的差异。这些结果表明，至 DWI 时间和 DWI 病变模式可能对 TIA 的诊断和治疗很重要。
