title: Value of Whole Brain Computed Tomography Perfusion for Predicting Outcome after TIA or Minor Ischemic Stroke.
abstract: BACKGROUND
  About 15% of patients with transient ischemic attack (TIA) or minor ischemic stroke have functional impairment after 3 months. We studied the role of whole brain computed tomography perfusion (WB-CTP) in the emergency diagnosis of TIA or minor stroke in predicting disability at 3 months.
  
  
  METHODS
  We included patients with ongoing symptoms of a TIA or minor stroke with a National Institutes of Health Stroke Scale (NIHSS) score less than 4 who were evaluated with noncontrast CT (NCCT), CT angiography (CTA), and WB-CTP within 24 hours of symptom onset. Patients treated with thrombolysis or a premorbid modified Rankin Scale (mRS) score greater than 1 were excluded. The association between clinical or imaging features and disability (mRS score ≥2) at 3 months was analyzed with Poisson regression. Potential additional prognostic value of WB-CTP was assessed with logistic regression.
  
  
  RESULTS
  We included 115 patients in 2012 to 2013. Median age was 68 years, and 66% were men. At 3 months, 20 patients (17%) were disabled. NIHSS score on admission (relative risk [RR], 3.6; 95% confidence interval [CI], 1.4-9.3), female sex (RR, 2.4; 95% CI, 1.1-5.3), early ischemic changes on NCCT (RR, 5.0; 95% CI, 2.6-9.9), extracranial or intracranial vessel stenosis ≥50% on CTA (RR, 3.0; 95% CI, 1.4-6.4), and perfusion abnormalities on WB-CTP (RR, 11.4; 95% CI, 4.6-28.2) were associated with disability at 3 months. In multivariable analysis, the relation between perfusion abnormalities and poor outcome remained essentially the same. WB-CTP showed prognostic value in addition to proved clinical and imaging predictors of disability.
  
  
  CONCLUSIONS
  WB-CTP is useful to identify patients with TIA or minor ischemic stroke at high risk of functional impairment at 3-month follow-up.
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands. Electronic address: i.r.van_den_wijngaard@lumc.nl.
authors.forename: Ido R
authors.initials: IR
authors.lastname: van den Wijngaard
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama À Nijeholt
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: van Walderveen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012372:ROC Curve; D011859:Radiography; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D015898:Tomography Scanners, X-Ray Computed
keywords: Minor ischemic stroke; computed tomography perfusion; disability; transient ischemic attack