Assessing Acute DWI Lesions in Clinically Diagnosed TIA: Insights from a Cohort Study in Cluj, Romania

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Clinically diagnosed transient ischemic attack (TIA) (n=26). Intervention: Diffusion-weighted MRI (MRI-DWI) within 1 week of symptom onset. Primary outcome: Prevalence of acute ischemic lesions on MRI-DWI (reclassification as minor ischemic stroke) (95% CI 11.6-47.8%).

Q: What does this research mean for the field?

MRI-DWI performed within the first week of symptom onset identifies acute ischemic lesions in approximately 27% of clinically diagnosed TIA patients, reclassifying them as minor ischemic strokes. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

K Arif; Ioan Ştefan Florian; Ioan Alexandru Florian; Alina Vasilica Blesneag; Enola Maer; Răzvan Mircea Cherecheș

doi:10.3390/tomography11040040

March 27, 2025TomographyOpen Access

Assessing Acute DWI Lesions in Clinically Diagnosed TIA: Insights from a Cohort Study in Cluj, Romania

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Key result

Early MRI-DWI detects acute infarction in ~27% of clinical TIA patients, reclassifying them as minor stroke.

95% CI 11.6-47.8%
n=26

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Why the study?

Under the updated tissue-based definition of TIA, this study aimed to determine the prevalence of ischemic lesions on DWI in patients clinically diagnosed with a TIA.

What is the prevalence of acute ischemic lesions detected by MRI-DWI within the first week after symptom onset in adults clinically diagnosed with a transient ischemic attack?

Key Points

To determine the prevalence of acute ischemic brain lesions on diffusion-weighted MRI in patients clinically diagnosed with a transient ischemic attack.
Retrospective observational cohort study of adults aged 18–90 years clinically diagnosed with a TIA by a neurologist at CMT hospital between May 2023 and July 2024 (N=26).
Patients underwent MRI with diffusion-weighted imaging (DWI) within the first week after symptom onset alongside evaluations of vascular risk factors and Fazekas scale grades.
Acute ischemic lesions on DWI were detected in 26.9% (7/26; 26.92%, 95% CI: 11.6–47.8%) of patients, reclassifying these cases as minor ischemic strokes under tissue-based definitions.
Fazekas grade 2 microangiopathy was the most frequent grade (46.15%, n=12), followed by grade 1 (38.46%, n=10), but ischemic lesion occurrence showed no statistically significant association with Fazekas severity (Fisher's exact test, p > 0.05).

Study Design

Type

Cohort (n=26)

Multicenter

No

Structured PICO

What is the prevalence of acute ischemic lesions detected by MRI-DWI within the first week after symptom onset in adults clinically diagnosed with a transient ischemic attack?

P

Population

26 adults in Cluj, Romania (mean age 66.19 years, 46.15% female) with a clinical diagnosis of TIA without infarction on CT scan who underwent brain MRI-DWI within the first week of symptom onset.

E

Exposure

Brain MRI with diffusion-weighted imaging (DWI) using 1.5 T (GE Optima MR360 Advance) or 3.0 T (Philips Ingenia Omega HP) systems with 4 mm slice thickness performed within the first week after symptom onset.

O

Outcome

Prevalence of acute ischemic lesions in MRI-DWI (reclassifying clinical TIA cases as minor ischemic strokes under the tissue-based definition) within 7 days of symptom onset.surrogate

Limitations

Retrospective observational design
Small sample size (n = 26) and predominantly Caucasian single-center cohort
Absence of a control group and lack of long-term follow-up data
Variability and delays in timing of MRI-DWI (up to 7 days after symptom onset) and use of 4 mm slice thickness without high-resolution sequences
Inability to perform multivariate analyses adjusting for confounders or evaluate ABCD2 scores for all participants
Retrospective design with no follow-up visits or control group
Small sample size (n = 26) and predominantly Caucasian single-region cohort limiting statistical power, multivariate adjustment, and generalizability
Variability in timing of MRI-DWI (up to 7 days after symptom onset), which may miss reversed lesions or detect new silent lesions
Standard 4 mm slice thickness on 1.5 T or 3 T MRI may have reduced sensitivity for small or posterior circulation lesions
ABCD2 scores were not available for all participants

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Answers are grounded in this paper and cite their sources.

Implication

Early MRI-DWI within the first week of symptom onset identified acute ischemic lesions in 26.9% of clinically diagnosed TIA patients in a Romanian cohort, reclassifying them as minor ischemic strokes and supporting routine tissue-based imaging to guide secondary stroke prevention.

Abstract

BACKGROUND: The updated definition of a TIA emphasizes tissue characteristics rather than symptom duration, defining a TIA as a transient neurological episode without ischemic lesions in brain imaging, including in DWI. If imaging reveals a lesion, even in patients with transient symptoms, the event is reclassified as a minor ischemic stroke. OBJECTIVE: This retrospective observational study aimed to determine the prevalence of ischemic lesions in DWI in patients with a TIA diagnosis. RESULTS: Adults aged 18-90 years, diagnosed with a TIA by a neurologist and who underwent MRI-DWI at CMT hospital within the first week after symptom onset (May 2023-July 2024), were included. Ethical approval was obtained. Descriptive statistics summarized patient demographics, clinical features, Fazekas scale grades, and imaging findings. CONCLUSIONS: Among the 26 patients clinically diagnosed with TIAs, 7 (26.9%) exhibited ischemic lesions in DWI, reclassifying these cases as minor ischemic strokes under the updated definition. The prevalence of ischemic lesions was notably higher in patients with comorbidities such as hypertension and diabetes. These findings highlight the importance of early MRI-DWI to accurately distinguish TIAs from minor ischemic strokes. Routine urgent DWI within the first week of TIA symptoms enhances diagnosis and risk stratification and can guide targeted stroke prevention strategies, particularly when combined with the ABCD2 score.

Discussion

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Cite This Study

Arif et al. (2025) conducted a cohort in Clinically diagnosed transient ischemic attack (TIA) (n=26). Diffusion-weighted MRI (MRI-DWI) within 1 week of symptom onset was evaluated on Prevalence of acute ischemic lesions on MRI-DWI (reclassification as minor ischemic stroke) (95% CI 11.6-47.8%). MRI-DWI within the first week detected acute ischemic lesions in 26.92% (7/26; 95% CI 11.6-47.8%) of clinically diagnosed TIA patients, reclassifying them as minor ischemic strokes.

synapsesocial.com/papers/6a7896f16789de8d0af7db14 https://doi.org/10.3390/tomography11040040

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Assessing Acute DWI Lesions in Clinically Diagnosed TIA: Insights from a Cohort Study in Cluj, Romania

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Assessing Acute DWI Lesions in Clinically Diagnosed TIA: Insights from a Cohort Study in Cluj, Romania

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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