Yuan Junliang, Jia Zejin, Song Yangguang, Yang Shuna, Li Yue, Yang Lei, Qin Wei, Hu Wenli
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2019 Jul 16;10:764. doi: 10.3389/fneur.2019.00764. eCollection 2019.
The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients. Between Jan 2017 and Dec 2018, we retrospectively enrolled 430 patients with a clinical diagnosis of TIA who underwent DWI. Patients were divided into those with acute ischemic lesions (DWI positive group) and those without (DWI negative group). The clinical characteristics, laboratory data, and imaging parameters were compared between the two groups. A total of 430 time-based TIA patients (mean age, 61.4 ± 13.0) were enrolled in this study. About 126 (29.3%) of TIA patients had a DWI positive lesion in our series. Comparing TIA patients with positive DWI to those with negative DWI, acute lesions were more likely to be more male, have higher hyperlipidemia and a smoking history, more speech abnormalities and increased motor weakness; and higher systolic and diastolic blood pressure, homocysteine, fasting blood glucose, and the scores of ABCD2, ABCD3, ABCD3-I, and Dawson. Several independent predictors of DWI positivity were identified with logistic regression analysis: motor weakness (odds ratio 4.861, = 0.021), speech abnormalities (odds ratio 4.029, = 0.024), and ABCD3-I (odds ratio 13.141, = 0.001). ABCD3-I showed the greatest area under the ROC curve, with a sensitivity of 85.7% and specificity of 72.4%. In patients with a clinical diagnosis of TIA, 29.3% demonstrated acute DWI lesions on brain magnetic resonance imaging (MRI). They were associated with motor weakness, speech abnormalities and higher ABCD3-I score at admission.
临床诊断为短暂性脑缺血发作（TIA）的患者，其临床特征与弥散加权成像（DWI）阳性之间的关联仍未得到充分理解。我们研究的目的是通过DWI确定TIA相关急性梗死的发生率，并确定TIA患者DWI阳性的潜在预测因素。在2017年1月至2018年12月期间，我们回顾性纳入了430例临床诊断为TIA且接受了DWI检查的患者。患者被分为有急性缺血性病变的患者（DWI阳性组）和无急性缺血性病变的患者（DWI阴性组）。比较了两组患者的临床特征、实验室数据和影像参数。本研究共纳入了430例基于时间的TIA患者（平均年龄61.4±13.0岁）。在我们的数据系列中，约126例（29.3%）TIA患者存在DWI阳性病变。将DWI阳性的TIA患者与DWI阴性的患者进行比较，急性病变更常见于男性，高脂血症和吸烟史发生率更高，言语异常和运动无力更常见；收缩压和舒张压、同型半胱氨酸、空腹血糖以及ABCD2、ABCD3、ABCD3-I和Dawson评分更高。通过逻辑回归分析确定了DWI阳性的几个独立预测因素：运动无力（比值比4.861，P = 0.021）、言语异常（比值比4.029，P = 0.024）和ABCD3-I（比值比13.141，P = 0.001）。ABCD3-I在ROC曲线下的面积最大，敏感性为85.7%，特异性为72.4%。在临床诊断为TIA的患者中，29.3%在脑磁共振成像（MRI）上显示有急性DWI病变。它们与运动无力、言语异常以及入院时较高的ABCD3-I评分相关。
