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Discriminating migraine aura from transient ischemic attack using MRI-based oxygen metabolism mapping: A preliminary

P Pernot1, A Bani-Sadr2,3, E Ong1

  • 1Department of Stroke Medicine, Neurological Hospital P. Wertheimer, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Bron, France.

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Migraine aura (MA) can mimic stroke. New MRI techniques measuring oxygen extraction fraction (OEF) show higher OEF in MA patients compared to TIA patients, aiding diagnosis.

Keywords:
magnetic resonance imagingmigraine auraoxygen metabolismretrospective studiestransient ischemic attack

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Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Migraine aura (MA) is a frequent mimic of acute stroke.
  • Clinical differentiation between MA and transient ischemic attack (TIA) is challenging.
  • Routine MRI may not reliably distinguish MA from TIA.

Purpose of the Study:

  • To evaluate the utility of cerebral oxygen metabolism maps in differentiating MA from TIA.
  • To investigate the impact of oxygen extraction fraction (OEF) on differential diagnosis.

Main Methods:

  • Retrospective diagnostic accuracy study (2012-2024) at Lyon Stroke Center.
  • Included patients with emergency MRI and final diagnosis of MA or TIA.
  • Utilized dynamic susceptibility-weighted (DSC) perfusion MRI post-processing for OEF estimation.

Main Results:

  • 53 patients included (39 MA, 14 TIA).
  • Significantly higher OEF in MA patients compared to TIA patients (median change +15% vs -8%, p<0.001).
  • OEF ratio showed high diagnostic accuracy (AUC 0.89) and was an independent predictor of MA.

Conclusions:

  • Migraine aura is associated with a focal increase in OEF during the acute phase.
  • OEF mapping using DSC perfusion MRI may assist in differentiating MA from TIA.
  • Further research is required to confirm the clinical utility of OEF mapping.