Background and Purpose- With the lack of confirmatory examinations, the distinction of a transient ischemic attack (TIA) from various TIA-mimicking diseases is difficult, particularly in diffusion-weighted imaging (DWI)-negative TIAs. In this study, we aimed to evaluate the relationship between arterial spin labeling (ASL) perfusion defects and early ischemic recurrence (FU-DWI [+]) in patients with DWI-negative TIAs. Methods- We assessed consecutive patients with a DWI-negative TIA within 24 hours of symptom onset, who underwent both ASL images and follow-up magnetic resonance imaging during the acute period. As markers of the ASL images, we evaluated the ASL perfusion defects in each hemisphere. Arterial transit artifact (ATA) and intraarterial high-intensity signal (IAS) were also rated as markers of collateral status and blood stagnation due to large vessel occlusion, respectively. Results- Among the 136 patients with a DWI-negative TIA, 33 patients had FU-DWI (+) lesions in 36 hemispheres. In the multivariable analysis, ASL defects remained an independent predictor of FU-DWI (+) (adjusted odds ratio, 13.94 [95% CI, 5.77-33.70], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.

中文翻译：

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短暂性脑缺血发作患者的局部动脉自旋标记灌注缺陷与早期缺血复发有关。

背景与目的-由于缺乏确定性检查，很难将短暂性脑缺血发作（TIA）与各种TIA模拟疾病区分开，特别是在弥散加权成像（DWI）阴性的TIA中。在这项研究中，我们旨在评估DWI阴性TIA患者的动脉自旋标记（ASL）灌注缺陷与早期缺血性复发（FU-DWI [+]）之间的关系。方法-我们评估了在症状发作后24小时内连续DWI阴性TIA的患者，这些患者在急性期均接受了ASL图像和后续的磁共振成像检查。作为ASL图像的标记，我们评估了每个半球的ASL灌注缺陷。动脉运输伪影（ATA）和动脉内高强度信号（IAS）也分别被评定为由于大血管闭塞而引起的侧支状态和血液停滞的标志。结果-在DWI阴性TIA的136例患者中，有33例在36个半球出现FU-DWI（+）病变。在多变量分析中，ASL缺陷仍然是FU-DWI（+）的独立预测因子（调整后的优势比为13.94 [95％CI，5.77-33.70]，P <0.001）。在评估ASL缺陷与ATA / IAS之间的交互关系时，（ASL [+] ATA [-]）组显示了FU-DWI（+）事件的最高频率（55.6％），具有最高的调整比值比值（调整后的优势比为14.86 [95％CI，5.63-39.24]，P <0.001），表明ASL缺陷与ATA之间具有负协同作用。同时，（ASL [+] IAS [+]）组比（ASL [+] IAS [-]）和（ASL [-] IAS [ -]）组，表明具有积极的协同作用。结论-我们证明了DWI阴性TIA患者的ASL灌注缺陷与同侧FU-DWI（+）有关。此外，IAS增强了这种关联，而ATA则减弱了这种关联。