title: Perfusion deficits detected by arterial spin-labeling in patients with TIA with negative diffusion and vascular imaging.
abstract: OBJECTIVE
  A substantial portion of clinically diagnosed TIA cases is imaging-negative. The purpose of the current study is to determine if arterial spin-labeling is helpful in detecting perfusion abnormalities in patients presenting clinically with TIA.
  
  
  METHODS
  Pseudocontinuous arterial spin-labeling with 3D background-suppressed gradient and spin-echo was acquired on 49 patients suspected of TIA within 24 hours of symptom onset. All patients were free of stroke history and had no lesion-specific findings on general MR, DWI, and MRA sequences. The calculated arterial spin-labeling CBF maps were scored from 1-3 on the basis of presence and severity of perfusion disturbance by 3 independent observers blinded to patient history. An age-matched cohort of 36 patients diagnosed with no cerebrovascular events was evaluated as a control. Interobserver agreement was assessed by use of the Kendall concordance test.
  
  
  RESULTS
  Scoring of perfusion abnormalities on arterial spin-labeling scans of the TIA cohort was highly concordant among the 3 observers (W = 0.812). The sensitivity and specificity of arterial spin-labeling in the diagnosis of perfusion abnormalities in TIA was 55.8% and 90.7%, respectively. In 93.3% (70/75) of the arterial spin-labeling CBF map readings with positive scores (≥2), the brain regions where perfusion abnormalities were identified by 3 observers matched with the neurologic deficits at TIA onset.
  
  
  CONCLUSIONS
  In this preliminary study, arterial spin-labeling showed promise in the detection of perfusion abnormalities that correlated with clinically diagnosed TIA in patients with otherwise normal neuroimaging results.
authors.affiliation: Departments of Radiological Sciences.
authors.forename: X J
authors.initials: XJ
authors.lastname: Qiao
authors.forename: N
authors.initials: N
authors.lastname: Salamon
authors.forename: D J J
authors.initials: DJ
authors.lastname: Wang
authors.forename: R
authors.initials: R
authors.lastname: He
authors.forename: M
authors.initials: M
authors.lastname: Linetsky
authors.forename: B M
authors.initials: BM
authors.lastname: Ellingson
authors.forename: W B
authors.initials: WB
authors.lastname: Pope
mesh_terms: D000368:Aged; D000465:Algorithms; D002536:Cerebral Arteries / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D002546:Ischemic Attack, Transient / Q000473:pathology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels
chemical_list: D013113:Spin Labels