Evaluation Of The Application Value Of PWI Combined With ABCD~2 Score In The Prognosis Of TIA Disease

BackgroundIn recent years,the concept of transient ischemic attack?TIA?has changed from a benign clinical symptom to a kind of medical emergency.Although the clinical manifest-ations of TIA and ischemic stroke are different,from the aspect of pathophysiology and etiology,the outcome changes were consistent.Data showed that patients with TIA had a significantly higher risk of ischemic stroke,and that 4%²0%of patients with TIA had stroke within 90 days,among these cases,most patients suffered the stroke within 7 days after the onset of TIA^[1].However,the clinical diagnosis of TIA was highly subjective.About 2/3 of the patients with TIA have no signs of cerebral ischemia on DWI imaging^[2].Clinical parameters are still unsatisfactory in predicting the risk of ischemic stroke after TIA.The issues of diagnosing hyperacute stage in pathophysiological stage of ischemic stroke,early treatment,early containment of pathological development and reversal of damaged neurological function are of great significance.ObjectiveTo investigate the clinical value of PWI combined with ABCD² score in predicting the outcome and prognosis of transient ischemic attack?TIA?.Methods56 patients with TIA in Xinxiang Central Hospital from June 2015 to June 2016 were selected and were examined by perfusion-weighted imaging?PWI?,diffusion-weighted imaging?DWI?as well as magnetic resonance angiography?MRA?within 24 hours after onset of disease,when there was no acute cerebral infarction in DWI images,the ABCD²score was applied immediately,the incidence of cerebral infarction within 7d among those patients would be followed-up and observed.Results23 cases?41.1%?had cerebral infarction in 56 patients with TIA within 7 days.The incidence of cerebral infarction in the low risk group of ABCD² score was lower than that in the middle risk group and the high risk group within 7 days,the middle risk group was lower than the high risk group,the difference was statistically significant?P<0.05?.The incidence of cerebral infarction in the patients with positive MR-PWI examination was significantly higher than that in the negative patients within 7 days,and the difference was statistically significant?P<0.05?.Intracranial vascular stenosis?P=0.004?and the time from symptom onset to MRI scan?P=0.003?are the influencing factors of MR-PWI positive results.The shorter the interval from symptom onset to MRI scan,the more likely the PWI is abnormal perfusion.Logistic regression analysis showed that PWI positive?OR=2.998?95%CI:1.456-6.172?P=0.003??ABCD² score?OR=3.765?95%CI:1.193-11.878?P=0.024??intracranial vascular stenosis?OR=4.743?95%CI:2.109-10.667?P<0.001?and atrial fibrillation?OR=3.051?95%CI:1.185-7.855?P=0.021?are important influencing factors of cerebral infarction of TIA within 7 days.The results of ROC curve analysis showed that PWI combined with ABCD² had a high clinical value in predicting the prognosis of TIA disease.Conclusion1.This study shows that intracranial vascular stenosis is a influencing factor in the results of positive MR-PWI.The shorter the interval from symptom onset to MRI scan,the more prone to abnormal perfusion of PWI.2.This study shows that the positive results of MR-PWI?ABCD² score?intracranial vascular stenosis and atrial fibrillation are important factors influencing the occurrence of cerebral infarction within 7 days after TIA,and they were all independent influencing factors.3.This study shows that the ABCD² score combined with PWI can predict the prognosis and outcome of TIA effectively,and have high clinical value in predicting secondary cerebral infarction in TIA.