Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Eur J Radiol. 2022 Sep;154:110427. doi: 10.1016/j.ejrad.2022.110427. Epub 2022 Jun 28.
Acute neurovascular imaging including MRA and/or CTA are routinely performed in the emergency departments (ED) for patients who present with suspected transient ischemic attacks (TIA). Given the current emphasis on mitigating the rising cost of health care nationally, and promoting high value practice, we sought to determine 1) the value of acute neurovascular imaging in patients presenting to the ED with TIA-like symptoms, and 2) whether these neurovascular studies led to a difference in management strategies.
We retrospectively reviewed 398 ED patients who presented with transient neurological deficits and underwent neurovascular imaging from 2015 to 2018. We reviewed diffusion weighted imaging (DWI) and neurovascular results by patient demographics, baseline risk factors, final diagnosis, treatment/management dispositions and three-month follow-up.
28.1% (112/398) of patients were diagnosed with true TIA, whereas 71.9% patients were deemed to have a non-vascular etiology. Total rates of positive MRA/CTA for severe intracranial (>50%) and cervical vessel (>70%) stenosis were 10.5% and 1.7%. Patients with positive DWI scans had significantly higher rates of severe vascular stenosis (24.4% versus 7.8% intracranially and 2.4% versus 0.9% in the neck) compared to those with negative DWI scans. All patients were treated with multi-pronged medical therapies with no immediate surgical intervention. A follow-up stroke was equally likely in TIA patients with or without severe vascular stenosis.
In patients presenting with TIA-like symptoms and DWI negative scans, the overall rate of positive neurovascular studies is very low. Triaging with DWI can reduce the frequency of unnecessary neurovascular imaging.
在急诊科（ED）为疑似短暂性脑缺血发作（TIA）患者进行急性神经血管成像（包括 MRA 和/或 CTA）是常规操作。鉴于目前国家对医疗成本上升的重视以及对高价值医疗实践的推动，我们旨在确定 1）在以 TIA 样症状就诊的 ED 患者中进行急性神经血管成像的价值，以及 2）这些神经血管研究是否导致管理策略的差异。
我们回顾性分析了 2015 年至 2018 年间在 ED 就诊的 398 例短暂性神经功能障碍患者的神经血管成像资料。我们根据患者的人口统计学、基线风险因素、最终诊断、治疗/管理处置以及 3 个月的随访情况对弥散加权成像（DWI）和神经血管结果进行了回顾。
28.1%（112/398）的患者被诊断为真正的 TIA，而 71.9%的患者被认为存在非血管病因。总 MRA/CTA 阳性率为颅内（>50%）和颈部血管（>70%）重度狭窄分别为 10.5%和 1.7%。与 DWI 扫描阴性的患者相比，DWI 扫描阳性的患者颅内严重血管狭窄的发生率显著更高（24.4%比 7.8%，颈部 2.4%比 0.9%）。所有患者均接受了多管齐下的药物治疗，无立即手术干预。无论是否存在严重血管狭窄，TIA 患者发生随访性卒中的可能性都相等。
在以 TIA 样症状和 DWI 扫描阴性就诊的患者中，神经血管研究阳性的总体发生率非常低。DWI 分诊可减少不必要的神经血管成像。
