FLAIR vascular hyperintensities predict early ischemic recurrence in TIA

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Transient ischemic attack (TIA) is a critical warning sign for future stroke.
• Identifying patients with TIA who are at high risk for early recurrence is essential for timely intervention.
• Early ischemic lesions on diffusion-weighted imaging (DWI) indicate a higher risk of recurrent stroke.

Purpose of the Study:

• To investigate the association between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) and the presence of early ischemic lesions on follow-up DWI (FU-DWI [+]) in patients with TIA but no visible lesions on initial MRI.
• To determine if FVH is an independent predictor of early lesion recurrence.
• To compare 1-year clinical outcomes between patients with and without FU-DWI (+).

Main Methods:

• A cohort of patients with lesion-negative TIA within 24 hours of symptom onset were recruited.
• Follow-up MRI including FLAIR and DWI was performed during the acute period.
• FVH was defined as focal or serpentine high signal intensity on FLAIR images.
• Multivariate analysis was used to assess the association between FVH and FU-DWI (+), adjusting for confounders like time to MRI and intracranial atherosclerosis.
• 1-year rates of recurrent ischemic stroke or TIA were compared between groups.

Main Results:

• Of 392 patients with lesion-negative TIA, 82 (20.9%) had FU-DWI (+).
• FVH was an independent predictor of FU-DWI (+) (adjusted odds ratio [aOR] = 4.77, 95% CI 2.45-9.29, p < 0.001).
• Time to initial MRI and intracranial atherosclerosis were also associated with FU-DWI (+).
• The FU-DWI (+) group had a significantly higher rate of 1-year recurrent ischemic stroke (10.7% vs 3.1%, p = 0.007).

Conclusions:

• FVH is a significant independent predictor of early ischemic lesion recurrence in patients with TIA and initially negative DWI.
• The presence of FU-DWI (+) in the acute period is associated with worse clinical outcomes, including a higher risk of recurrent stroke within one year.
• FVH serves as a valuable radiologic marker for identifying TIA patients at increased risk for early lesion development and subsequent adverse events.