Matthieu Robitaille, Marcel Émond, Mukul Sharma, Ariane Mackey, Pierre-Gilles Blanchard, Marie-Joe Nemnom, Marco L A Sivilotti, Ian G Stiell, Grant Stotts, Jacques Lee, Andrew Worster, Judy Morris, Ka Wai Cheung, Albert Y Jin, Demetrios J Sahlas, Heather E Murray, Steve Verreault, Marie-Christine Camden, Samuel Yip, Philip Teal, David J Gladstone, Mark I Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare Atzema, Tarik Slaoui, Jeanne Teitlebaum, George A Wells, Jeffrey J Perry
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In this study, we assessed the incidence of acute cerebral infarction on MRI in these patients, overall and stratified by the Canadian TIA Score levels and then we assessed subsequent stroke rates at 7, 30 and 90 days based on the presence of acute infarct on MRI.</p><p><strong>Methods: </strong>This pre-planned substudy of the Canadian TIA risk score cohort was conducted across 13 Canadian emergency departments over an 11-year period. Eligible patients included adult TIA/minor stroke patients with negative CT scans who underwent MRI within 7 days.</p><p><strong>Results: </strong>Among 11,507 patients, 1048 with negative CT scans had early MRI, which revealed infarction in 330 (31.5%) patients. Acute infarction rates varied by Canadian TIA Score risk group: 130 (15.4%) in low-risk, 754 (30.4%) in medium-risk, and 162 (50.0%) in the high-risk group. At 90 days, the rates of stroke in patients with a positive MRI were 2 (10.0%), 168 (22.3%), and 40 (24.7%) in low-risk, medium-risk, and high-risk groups, respectively. In comparison, in patients with a negative MRI the rate was 1 (0.9%), 7 (1.3%), and 4 (4.9%).</p><p><strong>Conclusions: </strong>Combining the Canadian TIA Risk Score with follow-up MRI improves stroke risk assessment. MRI enhance the accuracy of diagnosis TIA, especially when CT is negative. The risk score helps prioritize MRI, benefiting medium-risk patients most, while high-risk patients need prompt management regardless of MRI results. 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In this study, we assessed the incidence of acute cerebral infarction on MRI in these patients, overall and stratified by the Canadian TIA Score levels and then we assessed subsequent stroke rates at 7, 30 and 90 days based on the presence of acute infarct on MRI.</p><p><strong>Methods: </strong>This pre-planned substudy of the Canadian TIA risk score cohort was conducted across 13 Canadian emergency departments over an 11-year period. Eligible patients included adult TIA/minor stroke patients with negative CT scans who underwent MRI within 7 days.</p><p><strong>Results: </strong>Among 11,507 patients, 1048 with negative CT scans had early MRI, which revealed infarction in 330 (31.5%) patients. Acute infarction rates varied by Canadian TIA Score risk group: 130 (15.4%) in low-risk, 754 (30.4%) in medium-risk, and 162 (50.0%) in the high-risk group. 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引用次数: 0
摘要
背景：对于 CT 扫描结果正常的短暂性脑缺血发作（TIA）/轻微脑卒中患者，弥散加权磁共振成像（MRI）在预测后续脑卒中方面的作用尚不清楚，但已通过验证的加拿大 TIA 评分（Canadian TIA Score）除外。在本研究中，我们评估了这些患者 MRI 上急性脑梗死的发生率，包括总体发生率和按加拿大 TIA 评分分层的发生率，然后根据 MRI 上急性脑梗死的发生率评估了 7 天、30 天和 90 天后的脑卒中发生率：这项预先计划的加拿大 TIA 风险评分队列子研究在加拿大 13 个急诊科进行，历时 11 年。符合条件的患者包括 CT 扫描阴性且在 7 天内接受 MRI 检查的 TIA/轻度中风成年患者：结果：在 11,507 名患者中，1048 名 CT 扫描呈阴性的患者接受了早期 MRI 检查，其中 330 名患者（31.5%）发现了脑梗死。急性脑梗塞发生率因加拿大 TIA 评分风险组别而异：低风险组为 130 例（15.4%），中风险组为 754 例（30.4%），高风险组为 162 例（50.0%）。90 天后，磁共振成像呈阳性的患者中，低风险组、中风险组和高风险组的中风发生率分别为 2 例（10.0%）、168 例（22.3%）和 40 例（24.7%）。相比之下，核磁共振成像呈阴性的患者比例分别为1（0.9%）、7（1.3%）和4（4.9%）：结论：将加拿大 TIA 风险评分与磁共振成像随访相结合可改善卒中风险评估。磁共振成像提高了 TIA 诊断的准确性，尤其是在 CT 阴性的情况下。风险评分有助于确定磁共振成像的优先次序，中危患者受益最大，而高危患者无论磁共振成像结果如何都需要及时治疗。低风险患者可从磁共振成像中获益，以确定进一步的检查。
The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke.
Background: Diffusion weighted magnetic resonance imaging's (MRI) role in predicting subsequent strokes beyond the validated Canadian TIA Score in in transient ischemic attack (TIA)/minor stroke patients with normal CT scans is unknown. In this study, we assessed the incidence of acute cerebral infarction on MRI in these patients, overall and stratified by the Canadian TIA Score levels and then we assessed subsequent stroke rates at 7, 30 and 90 days based on the presence of acute infarct on MRI.
Methods: This pre-planned substudy of the Canadian TIA risk score cohort was conducted across 13 Canadian emergency departments over an 11-year period. Eligible patients included adult TIA/minor stroke patients with negative CT scans who underwent MRI within 7 days.
Results: Among 11,507 patients, 1048 with negative CT scans had early MRI, which revealed infarction in 330 (31.5%) patients. Acute infarction rates varied by Canadian TIA Score risk group: 130 (15.4%) in low-risk, 754 (30.4%) in medium-risk, and 162 (50.0%) in the high-risk group. At 90 days, the rates of stroke in patients with a positive MRI were 2 (10.0%), 168 (22.3%), and 40 (24.7%) in low-risk, medium-risk, and high-risk groups, respectively. In comparison, in patients with a negative MRI the rate was 1 (0.9%), 7 (1.3%), and 4 (4.9%).
Conclusions: Combining the Canadian TIA Risk Score with follow-up MRI improves stroke risk assessment. MRI enhance the accuracy of diagnosis TIA, especially when CT is negative. The risk score helps prioritize MRI, benefiting medium-risk patients most, while high-risk patients need prompt management regardless of MRI results. Low-risk patients benefit from MRI for determining further investigations.
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