Wang Yue, Xiao Jingjing, Luo Yu, Wang Shaoshi, Liang Huazheng, Jin Lingjing
Department of Neurology, Shanghai Fourth People's Hospital affiliated to Tongji University School of Medicine, Shanghai 200081, China.
Department of Neurology, Shanghai Tongji Hospital, Tongji University, Shanghai 200065, China.
Ann Transl Med. 2019 Dec;7(24):808. doi: 10.21037/atm.2019.12.69.
To assess the prevalence and potential predictors of MR diffusion and perfusion abnormalities in a Chinese population with hemispheric transient ischemic attacks (TIA).
Patients with temporary (<24 hours) focal cerebral dysfunction of probable vascular origin were considered to be potential candidates for this study in the emergency room. Those who were admitted to the stroke center of Shanghai Fourth People's Hospital affiliated to Tongji University between January 2015 and December 2018 were recruited to the present study. MRI, including both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), was performed within 7 days after the last symptom attack. Time to maximum of the residue function (Tmax) maps were auto-evaluated using the RAPID software to determine hypoperfusion. Multivariate analysis was used to assess the correlation of MR findings with clinical variables, medical history, cardio-metabolic characteristics, and the ABCD2 scores (age, blood pressure, clinical features, symptom duration and diabetes).
Sixty-six out of 207 patients met the inclusion criteria. Baseline MRI showed DWI lesions in 20 patients (30.3%). The prevalence of MR perfusion Tmax >4 s >0 mL and ≥10 mL were 77.3% (51/66) and 50% (33/66), respectively. Male patients tended to develop DWI lesions after a TIA. Limb weakness was an independent factor associated with MR perfusion abnormalities (Tmax >4 s ≥10 mL) in this Chinese population (adjusted OR =7.41, 95% CI: 1.57-34.89, P=0.011).
Our results suggest that limb weakness is a strong predictor of perfusion abnormalities calculated by RAPID on Tmax maps of hemispheric TIA patients without DWI positive findings. Male patients are more likely to develop cerebral infarction.
评估中国半球短暂性脑缺血发作（TIA）人群中磁共振扩散及灌注异常的患病率和潜在预测因素。
在急诊室，有短暂性（<24小时）可能源于血管性的局灶性脑功能障碍的患者被视为本研究的潜在候选对象。招募2015年1月至2018年12月期间入住同济大学附属上海第四人民医院卒中中心的患者进入本研究。在最后一次症状发作后7天内进行磁共振成像（MRI），包括扩散加权成像（DWI）和灌注加权成像（PWI）。使用RAPID软件自动评估残余函数最大值时间（Tmax）图，以确定灌注不足。采用多变量分析评估磁共振成像结果与临床变量、病史、心脏代谢特征及ABCD2评分（年龄、血压、临床特征、症状持续时间和糖尿病）之间的相关性。
207例患者中有66例符合纳入标准。基线MRI显示20例患者（30.3%）存在DWI病变。磁共振灌注Tmax>4秒、≥0毫升和≥10毫升的患病率分别为77.3%（51/66）和50%（33/66）。男性患者在TIA后更易出现DWI病变。肢体无力是该中国人群中与磁共振灌注异常（Tmax>4秒≥10毫升）相关的独立因素（校正比值比=7.41，95%置信区间：1.57-34.89，P=0.011）。
我们的结果表明，肢体无力是在半球TIA患者无DWI阳性发现的Tmax图上通过RAPID计算的灌注异常的有力预测因素。男性患者更易发生脑梗死。
