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Research ArticleBRAIN

Quantitative Diffusion-Weighted MR Imaging in Transient Ischemic Attacks

Ayeesha K. Kamal, Alan Z. Segal and Aziz M. Uluğ
American Journal of Neuroradiology October 2002, 23 (9) 1533-1538;
Ayeesha K. Kamal
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Alan Z. Segal
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Aziz M. Uluğ
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  • Fig 1.
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    Fig 1.

    A, Quantitative Dav map shows ROIs (boxes) in the location of clinically suspected region of brain (right motor cortex) and contralateral control site. These two measurements were used to calculate the ratio m1.

    B, Quantitative Dav map shows regions used for measurements made on right and left thalami (boxes) for calculating the control ratio of c1.

    C, Mean value of the brain tissue diffusion constant (BDav) and width of the distribution (σ) were determined from the distribution analysis map by using a three-compartmental model (see Methods). This value was used in determining the ratios m3 and c3. Data are shown as circles, and the fit is shown as a line.

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    Fig 2.

    Four measured ratios (m1, m2, c1, c2) are shown for all 12 patients. TIA-affected regions are compared with corresponding contralateral brain regions (m1) and to thalamic controls (m2) not affected by TIA (solid symbols). The resultant ratios are consistently below unity and are around 0.82. However, when regions of brain not affected by the TIA are compared (c1, c2), no interhemisperic difference is noted and the ratios approach unity (open symbols).

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    Fig 3.

    Patient with left hand and arm weakness (patient 8).

    A and B, DW image (A) and T2-weighted image (B) of an axial section through the motor cortex do not show any abnormality.

    C, Quantitative Dav map shows a dark region (arrow) in the right motor cortex.

Tables

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    TABLE 1:

    Clinical Presentation and Stroke Risk Factors

    Patient no.Age (y)/SexStroke Risk FactorsClinical PresentationSymptom Duration (hrs)
    182/FHTN, HLD, CADNonfluent aphasia and mild right hemiparesis0.5
    232/FIDDMFluent aphasia, left gaze preference and right hemiparesis4
    391/FCHF, CADFluent aphasia10
    439/FSmokingFace, arm, leg numbness; no weakness. No sensory inattention0.25
    578/FHTN, DMNonfluent aphasia3
    681/FAF*vertigo and gait ataxia2
    776/MCADIsolated right hand and arm weakness, no aphasia0.75
    868/FHTNLeft arm and hand weakness,6
    sensory neglect
    977/MHTN, AF*Left facial weakness, left hand clumsiness, dysarthria and left dysdiadochokinesia0.5
    1054/MSmoking, HTNComplete speech arrest and mild right pronator drift0.5
    1176/MHTNComplete speech arrest0.17
    1281/MCAD, HTNDysarthria, left facial and left hemiparesis0.42
    • Note. AF indicates atrial fibrillation, CAD, coronary artery disease, CHF, congestive heart failure; DM, diabetes mellitus; HLD, hyperlipidaemia, HTN, hypertension; IDDM, insulin-dependent diabetes mellitus.

    • * Not receiving anticoagulation therapy.

    • View popup
    TABLE 2:

    Diffusion Measurements

    Patient No.TIA LocationROI Measurements* (10−3 mm2/s)Fit† (10−3 mm2/s)
    Ipsilateral ROIContralateral ROIIpsilateral ThalamusContralateral ThalamusBDavσ
    1Broca0.620 ± 0.0750.796 ± 0.0770.777 ± 0.0080.771 ± 0.0420.7660.189
    2Wernicke0.636 ± 0.0050.713 ± 0.0530.720 ± 0.0460.738 ± 0.0820.7650.180
    3Wernicke0.716 ± 0.0670.852 ± 0.0840.855 ± 0.0600.873 ± 0.0640.8370.181
    4R thalamus0.619 ± 0.0290.730 ± 0.484(0.770 ± 0.090)‡(0.772 ± 0.079)‡0.7490.188
    5Broca0.834 ± 0.0621.111 ± 0.1051.204 ± 0.1021.162 ± 0.0840.8540.218
    6L pons0.606 ± 0.0870.806 ± 0.0310.736 ± 0.0830.725 ± 0.0790.7870.202
    7L motor cortex0.685 ± 0.0620.795 ± 0.0450.743 ± 0.0900.743 ± 0.0670.7680.191
    8R motor cortex0.677 ± 0.0440.780 ± 0.0590.790 ± 0.1030.770 ± 0.0860.7680.174
    9L pons0.606 ± 0.0110.745 ± 0.0280.774 ± 0.0510.783 ± 0.0760.7850.207
    10Broca0.613 ± 0.0370.681 ± 0.0500.750 ± 0.1070.745 ± 0.0910.7390.174
    11Broca0.724 ± 0.0550.799 ± 0.0780.721 ± 0.0870.717 ± 0.0590.7730.183
    12R pons0.518 ± 0.0590.699 ± 0.0030.800 ± 0.1070.802 ± 0.1060.8090.212
    Mean0.6540.7920.8030.8000.7830.192
    SD0.0800.1120.1320.2500.0340.015
    • Note.— L indicates left; R, right.

    • * Data are the mean ± SD of the measurements.

    • † Error of fit is 0.01 10−3 mm2/s. BDav is the mean of the average diffusion constant distribution measured from the entire brain tissue. σ is the width of this distribution (8).

    • ‡ Instead of thamali, caudate nuclei were used as control in this patient because TIA involved the right thalamus.

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American Journal of Neuroradiology: 23 (9)
American Journal of Neuroradiology
Vol. 23, Issue 9
1 Oct 2002
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Quantitative Diffusion-Weighted MR Imaging in Transient Ischemic Attacks
Ayeesha K. Kamal, Alan Z. Segal, Aziz M. Uluğ
American Journal of Neuroradiology Oct 2002, 23 (9) 1533-1538;

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Quantitative Diffusion-Weighted MR Imaging in Transient Ischemic Attacks
Ayeesha K. Kamal, Alan Z. Segal, Aziz M. Uluğ
American Journal of Neuroradiology Oct 2002, 23 (9) 1533-1538;
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  • Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.
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  • Systematic Review of Associations Between the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging and Clinical Predictors of Early Stroke Risk After Transient Ischemic Attack
  • Long-Term Changes of Functional MRI-Based Brain Function, Behavioral Status, and Histopathology After Transient Focal Cerebral Ischemia in Rats
  • Higher Risk of Further Vascular Events Among Transient Ischemic Attack Patients With Diffusion-Weighted Imaging Acute Ischemic Lesions
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