Background

Migrainous aura (MA) represents the third most common stroke mimic (SM). Advanced neuroimaging is pivotal in the assessment of patients with focal neurological acute symptoms. We investigated brain perfusion alterations in MA-SM patients using a novel CT perfusion (CTP)-based quantitative approach in order to improve differential diagnosis between MA and acute stroke.

Methods

We processed and analysed the clinical and neuroimaging CTP data, acquired within 4.5 h from symptom onset, of patients with acute focal neurological symptoms receiving a final diagnosis of MA. The differences between ROI, compatible with MA symptoms, and contralateral side were automatically estimated in terms of asymmetry index (AI%) by the newly developed tool for mean transit time (MTT), CBF, and cerebral blood volume (CBV) CTP parameters. The AI% ≥ 10% was considered significant.

Results

Out of 923 admitted patients, 14 patients with MA were included. In 13 out of 14 cases, a significant pattern of hypoperfusion was observed by quantitative analysis in at least one of the CTP maps. In 7 patients, all three CTP maps were significantly altered. In particular, MTT-AI% increased in 11 (79%) cases, while CBF-AI% and CBV-AI% decreased in 12 (86%) and in 9 (64%) patients, respectively. All CBV values were above ischemic stroke core threshold and all MTT-AI were below ischemic penumbra threshold.

Conclusions

Our data suggest that a novel CTP-quantitative approach may detect during MA a moderate hypoperfusion pattern in the cerebral regions compatible with aura symptoms. The use of this novel tool could support differential diagnosis between MA and acute stroke.

中文翻译：

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一种新颖的基于计算机断层扫描灌注的定量工具，用于评估偏头痛性先兆卒中模拟物中的灌注异常。

背景

迁徙光环（MA）代表第三种最常见的中风模仿物（SM）。晚期神经影像检查对于评估局灶性神经系统急性症状的患者至关重要。我们使用一种新颖的基于CT灌注（CTP）的定量方法研究了MA-SM患者的脑灌注改变，以改善MA和急性中风之间的鉴别诊断。

方法

我们处理并分析了从症状发作后4.5小时内获得的具有最终诊断为MA的急性局灶性神经系统症状的患者的临床和神经影像CTP数据。通过新开发的平均通过时间（MTT），CBF和脑血容量（CBV）CTP参数的新工具，可以根据不对称指数（AI％）自动估算ROI，与MA症状相适应的对侧和对侧之间的差异。AI％≥10％被认为是显着的。

结果

在923名入院患者中，包括14名MA患者。在14例患者中，有13例通过定量分析在至少一张CTP图中观察到明显的灌注不足。在7例患者中，所有三张CTP图均发生了明显改变。特别是，11例（79％）病例的MTT-AI％增加，而12例（86％）和9例（64％）的CBF-AI％和CBV-AI％下降。所有CBV值均高于缺血性卒中核心阈值，所有MTT-AI均低于缺血性半影​​阈值。

结论

我们的数据表明，一种新颖的CTP定量方法可以在MA期间检测与先兆症状相适应的大脑区域中的中等灌注模式。使用这种新颖的工具可以支持MA和急性中风之间的鉴别诊断。