Title:Combining Diffusion-Weighted Imaging Patterns with ABCD2 Score Predicts Stroke Risk after Transient Ischemic Attack
Volume: 15
Issue: 4
Author(s): Lulu Pei, Bo Song, Hui Fang, Yuan Gao, Yinan Guo, Kai Liu, Yapeng Li, Xiao Wang, Xuan Tian, Jun Wu, Shilei Sun and Yuming Xu*
Affiliation:
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052,China
Keywords:
ABCD2 score, multiple infarctions, Diffusion-weighted Imaging (DWI), stroke, Transient Ischemic Attack (TIA),
prognosis.
Abstract: Background: Recent studies indicated that multiple acute infarctions on Diffusion-
Weighted Imaging (DWI) were associated with a higher risk of stroke.
Objective: The study aims to estimate the association of different infarction patterns and ABCD2
score with the prognosis of Transient Ischemic Attack (TIA).
Method: We prospectively analyzed the data from TIA database of the First Affiliated Hospital of
Zhengzhou University. The predictive outcome was a 90-day ischemic stroke. Cox proportional
hazards model was used to evaluate the predictive value of risk factors associated with stroke. The
receiver-operating characteristics curves were plotted, and the predictive value was assessed by
computing the Area Under the Curve (AUC).
Results: A total of 1376 eligible patients were enrolled. DWI patterns were significant predictors
for stroke (single acute infarction: hazard ratio [HR] =2.942, p <0.001; multiple acute infarctions:
HR =5.552, p <0.001, in comparison with no acute infarction). Patients with both multiple infarctions
and ABCD2 ≥4 were associated with approximately 15.5-fold risk of stroke at 90 days
(28.8% vs. 2.1%, HR =15.455, 95% confidence interval [CI], 7.946-30.057, p <0.001), compared
with those with no infarction or ABCD2 <4. The ABCD2+ DWI patterns showed a better discrimination
with an AUC of 0.765 (95% CI, 0.741–0.787) than the ABCD2 score (AUC =0.651;
95% CI, 0.625-0.676; Z =4.777; p <0.0001) and ABCD3-I score (AUC =0.724; 95% CI, 0.700-
0.748; Z =2.697; p =0.007).
Conclusion: Combining infarction patterns with ABCD2 score could enhance the predictive value
for early stroke risk in TIA.
