S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
FLAIR vascular hyperintensities predict early ischemic recurrence in transient ischemic attack
초기 병변이 없는 일과성 허혈 발작 환자에서 FLAIR 영상의 혈관 고강도 신호가 추적 영상 병변에 미치는 영향
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (석사)-- 서울대학교 대학원 : 의과대학 의학과, 2018. 8. 윤병우.
- Though lesion negative transient ischemic attack (TIA) patients accounted for considerable amounts in clinical fields, their diagnoses are interrupted with many mimic diseases (e.g., seizure, migraine, hypoglycemia, psychotic disease). To assess more objective diagnosis of true ischemic origin TIA patients, we evaluated the relationship between FLAIR vascular hyperintensity (FVH) and early ischemic lesion recurrence [FU-DWI (+)] in lesion negative transient ischemic attack (TIA) patients.
We recruited consecutive lesion negative TIA patients 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. Furthermore, to compare clinical outcomes between the FU-DWI (+) and FU-DWI (-) groups, we assessed 1-year recurrent ischemic stroke or TIA.
Among 392 lesion negative TIA patients, 82 patients had FU-DWI (+) on the follow-up MRI. In the multivariate analysis, FVH remained an independent predictor of FU-DWI (+) [adjusted OR (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% versus 3.1%, respectively, P = 0.007).
FVH is associated with FU-DWI (+) in lesion negative TIA patients. As FU-DWI (+) commonly occurs during the acute period and has a subsequent worse outcome after discharge, additional radiological or clinical markers for it are necessary.