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Abstract
Objective To evaluate the relationship between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) and early ischemic lesion recurrence (follow-up diffusion-weighted imaging [FU-DWI] [+]) in patients with lesion-negative TIA.
Methods We recruited consecutive patients with lesion-negative TIA within 24 hours of symptom onset, who underwent follow-up MRI during the acute period. FVH was defined as a focal or serpentine high signal intensity on FLAIR images. Other potential confounders were adjusted to evaluate the relationship between FVH and FU-DWI (+). Furthermore, to compare clinical outcomes between the FU-DWI (+) and FU-DWI (−) groups, we assessed 1-year recurrent ischemic stroke or TIA.
Results Among 392 patients with lesion-negative TIA, 82 patients had FU-DWI (+) on the follow-up MRI. In the multivariate analysis, FVH remained an independent predictor of FU-DWI (+) (adjusted odds ratio [aOR] = 4.77, 95% confidence interval [CI] 2.45–9.29, p < 0.001). The time to initial MRI (aOR = 0.49, 95% CI = 0.33–0.70, p < 0.001) and intracranial atherosclerosis (aOR = 2.07, 95% CI = 1.10–3.92, p = 0.025) were also associated with FU-DWI (+), independent of FVH. In clinical outcomes, the FU-DWI (+) group showed more frequent 1-year recurrent ischemic stroke events than the FU-DWI (−) group (10.7% vs 3.1%, respectively, p = 0.007).
Conclusions FVH is associated with FU-DWI (+) in patients with lesion-negative TIA. As FU-DWI (+) frequently occurs during the acute period and has a subsequent worse outcome after discharge, additional radiologic or clinical markers for it are necessary.
Glossary
- ABCD2 score=
- age, blood pressure, clinical features, duration of TIA, and presence of diabetes;
- aOR=
- adjusted odds ratio;
- CI=
- confidence interval;
- DWI=
- diffusion-weighted imaging;
- ECAS=
- extracranial atherosclerosis stenosis;
- FLAIR=
- fluid-attenuated inversion recovery;
- FU-DWI=
- follow-up diffusion-weighted imaging;
- FVH=
- fluid-attenuated inversion recovery vascular hyperintensity;
- ICAS=
- intracranial atherosclerosis stenosis;
- MRA=
- magnetic resonance angiography;
- TE=
- echo time;
- TR=
- repetition time
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received August 6, 2017.
- Accepted in final form November 30, 2017.
- © 2018 American Academy of Neurology
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