Diffusion-weighted imaging and diagnosis of transient ischemic attack

Miriam Brazzelli, Francesca M. Chappell, Hector Miranda, Kirsten Shuler, Martin Dennis, Peter A. G. Sandercock, Keith Muir, Joanna M. Wardlaw*

*Corresponding author for this work

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Abstract

Objective: Magnetic resonance (MR) diffusion-weighted imaging (DWI) is sensitive to small acute ischemic lesions and might help diagnose transient ischemic attack (TIA). Reclassification of patients with TIA and a DWI lesion as "stroke" is under consideration. We assessed DWI positivity in TIA and implications for reclassification as stroke.

Methods: We searched multiple sources, without language restriction, from January 1995 to July 2012. We used PRISMA guidelines, and included studies that provided data on patients presenting with suspected TIA who under-went MR DWI and reported the proportion with an acute DWI lesion. We performed univariate random effects meta-analysis to determine DWI positive rates and influencing factors.

Results: We included 47 papers and 9,078 patients (range = 18-1,693). Diagnosis was by a stroke specialist in 26 of 47 studies (55%); all studies excluded TIA mimics. The pooled proportion of TIA patients with an acute DWI lesion was 34.3% (95% confidence interval [CI] = 30.5-38.4, range = 9-67%; I-2 = 89.3%). Larger studies (n > 200) had lower DWI-positive rates (29%; 95% CI = 23.2-34.6) than smaller (n <50) studies (40.1%; 95% CI = 33.5-46.6%; p = 0.035), but no other testable factors, including clinician speciality and time to scanning, reduced or explained the 7-fold DWI-positive variation.

Interpretation: The commonest DWI finding in patients with definite TIA is a negative scan. Available data do not explain why 2/3 of patients with definite specialist-confirmed TIA have negative DWI findings. Until these factors are better understood, reclassifying DWI-positive TIAs as strokes is likely to increase variance in estimates of global stroke and TIA burden of disease.

Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalAnnals of Neurology
Volume75
Issue number1
Early online date2 Jan 2014
DOIs
Publication statusPublished - Jan 2014

Keywords

  • ASSOCIATION/AMERICAN STROKE ASSOCIATION
  • HEALTH-CARE PROFESSIONALS
  • MINOR STROKE
  • CLINICAL PREDICTORS
  • MRI FINDINGS
  • TIA PATIENTS
  • EARLY RISK
  • DEFINITION
  • STATEMENT
  • LESIONS

Cite this

Brazzelli, M., Chappell, F. M., Miranda, H., Shuler, K., Dennis, M., Sandercock, P. A. G., ... Wardlaw, J. M. (2014). Diffusion-weighted imaging and diagnosis of transient ischemic attack. Annals of Neurology, 75(1), 67-76. https://doi.org/10.1002/ana.24026

Diffusion-weighted imaging and diagnosis of transient ischemic attack. / Brazzelli, Miriam; Chappell, Francesca M.; Miranda, Hector; Shuler, Kirsten; Dennis, Martin; Sandercock, Peter A. G.; Muir, Keith; Wardlaw, Joanna M.

In: Annals of Neurology, Vol. 75, No. 1, 01.2014, p. 67-76.

Research output: Contribution to journalArticle

Brazzelli, M, Chappell, FM, Miranda, H, Shuler, K, Dennis, M, Sandercock, PAG, Muir, K & Wardlaw, JM 2014, 'Diffusion-weighted imaging and diagnosis of transient ischemic attack', Annals of Neurology, vol. 75, no. 1, pp. 67-76. https://doi.org/10.1002/ana.24026
Brazzelli M, Chappell FM, Miranda H, Shuler K, Dennis M, Sandercock PAG et al. Diffusion-weighted imaging and diagnosis of transient ischemic attack. Annals of Neurology. 2014 Jan;75(1):67-76. https://doi.org/10.1002/ana.24026
Brazzelli, Miriam ; Chappell, Francesca M. ; Miranda, Hector ; Shuler, Kirsten ; Dennis, Martin ; Sandercock, Peter A. G. ; Muir, Keith ; Wardlaw, Joanna M. / Diffusion-weighted imaging and diagnosis of transient ischemic attack. In: Annals of Neurology. 2014 ; Vol. 75, No. 1. pp. 67-76.
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abstract = "Objective: Magnetic resonance (MR) diffusion-weighted imaging (DWI) is sensitive to small acute ischemic lesions and might help diagnose transient ischemic attack (TIA). Reclassification of patients with TIA and a DWI lesion as {"}stroke{"} is under consideration. We assessed DWI positivity in TIA and implications for reclassification as stroke.Methods: We searched multiple sources, without language restriction, from January 1995 to July 2012. We used PRISMA guidelines, and included studies that provided data on patients presenting with suspected TIA who under-went MR DWI and reported the proportion with an acute DWI lesion. We performed univariate random effects meta-analysis to determine DWI positive rates and influencing factors.Results: We included 47 papers and 9,078 patients (range = 18-1,693). Diagnosis was by a stroke specialist in 26 of 47 studies (55{\%}); all studies excluded TIA mimics. The pooled proportion of TIA patients with an acute DWI lesion was 34.3{\%} (95{\%} confidence interval [CI] = 30.5-38.4, range = 9-67{\%}; I-2 = 89.3{\%}). Larger studies (n > 200) had lower DWI-positive rates (29{\%}; 95{\%} CI = 23.2-34.6) than smaller (n <50) studies (40.1{\%}; 95{\%} CI = 33.5-46.6{\%}; p = 0.035), but no other testable factors, including clinician speciality and time to scanning, reduced or explained the 7-fold DWI-positive variation.Interpretation: The commonest DWI finding in patients with definite TIA is a negative scan. Available data do not explain why 2/3 of patients with definite specialist-confirmed TIA have negative DWI findings. Until these factors are better understood, reclassifying DWI-positive TIAs as strokes is likely to increase variance in estimates of global stroke and TIA burden of disease.",
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AU - Brazzelli, Miriam

AU - Chappell, Francesca M.

AU - Miranda, Hector

AU - Shuler, Kirsten

AU - Dennis, Martin

AU - Sandercock, Peter A. G.

AU - Muir, Keith

AU - Wardlaw, Joanna M.

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N2 - Objective: Magnetic resonance (MR) diffusion-weighted imaging (DWI) is sensitive to small acute ischemic lesions and might help diagnose transient ischemic attack (TIA). Reclassification of patients with TIA and a DWI lesion as "stroke" is under consideration. We assessed DWI positivity in TIA and implications for reclassification as stroke.Methods: We searched multiple sources, without language restriction, from January 1995 to July 2012. We used PRISMA guidelines, and included studies that provided data on patients presenting with suspected TIA who under-went MR DWI and reported the proportion with an acute DWI lesion. We performed univariate random effects meta-analysis to determine DWI positive rates and influencing factors.Results: We included 47 papers and 9,078 patients (range = 18-1,693). Diagnosis was by a stroke specialist in 26 of 47 studies (55%); all studies excluded TIA mimics. The pooled proportion of TIA patients with an acute DWI lesion was 34.3% (95% confidence interval [CI] = 30.5-38.4, range = 9-67%; I-2 = 89.3%). Larger studies (n > 200) had lower DWI-positive rates (29%; 95% CI = 23.2-34.6) than smaller (n <50) studies (40.1%; 95% CI = 33.5-46.6%; p = 0.035), but no other testable factors, including clinician speciality and time to scanning, reduced or explained the 7-fold DWI-positive variation.Interpretation: The commonest DWI finding in patients with definite TIA is a negative scan. Available data do not explain why 2/3 of patients with definite specialist-confirmed TIA have negative DWI findings. Until these factors are better understood, reclassifying DWI-positive TIAs as strokes is likely to increase variance in estimates of global stroke and TIA burden of disease.

AB - Objective: Magnetic resonance (MR) diffusion-weighted imaging (DWI) is sensitive to small acute ischemic lesions and might help diagnose transient ischemic attack (TIA). Reclassification of patients with TIA and a DWI lesion as "stroke" is under consideration. We assessed DWI positivity in TIA and implications for reclassification as stroke.Methods: We searched multiple sources, without language restriction, from January 1995 to July 2012. We used PRISMA guidelines, and included studies that provided data on patients presenting with suspected TIA who under-went MR DWI and reported the proportion with an acute DWI lesion. We performed univariate random effects meta-analysis to determine DWI positive rates and influencing factors.Results: We included 47 papers and 9,078 patients (range = 18-1,693). Diagnosis was by a stroke specialist in 26 of 47 studies (55%); all studies excluded TIA mimics. The pooled proportion of TIA patients with an acute DWI lesion was 34.3% (95% confidence interval [CI] = 30.5-38.4, range = 9-67%; I-2 = 89.3%). Larger studies (n > 200) had lower DWI-positive rates (29%; 95% CI = 23.2-34.6) than smaller (n <50) studies (40.1%; 95% CI = 33.5-46.6%; p = 0.035), but no other testable factors, including clinician speciality and time to scanning, reduced or explained the 7-fold DWI-positive variation.Interpretation: The commonest DWI finding in patients with definite TIA is a negative scan. Available data do not explain why 2/3 of patients with definite specialist-confirmed TIA have negative DWI findings. Until these factors are better understood, reclassifying DWI-positive TIAs as strokes is likely to increase variance in estimates of global stroke and TIA burden of disease.

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KW - MRI FINDINGS

KW - TIA PATIENTS

KW - EARLY RISK

KW - DEFINITION

KW - STATEMENT

KW - LESIONS

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JO - Annals of Neurology

JF - Annals of Neurology

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