Diagnostic value of 3D arterial spin labeling plus diffusion-weighted imaging for transient ischemic attack and short-term stroke prognosis: A retrospective cohort study.

DWI detected acute lesions in only 34.9% of TIA patients, while 3D-ASL revealed cerebral hypoperfusion in 60.4%, including 35 DWI-negative cases.

• Study included 106 TIA patients and 58 healthy controls undergoing 3.0T MRI within 72 hours of symptom onset.
• DWI (b = 0, 1000 seconds/mm²) detected acute lesions in 37 patients (34.9%).
• 3D-ASL with dual post-labeling delays revealed cerebral hypoperfusion in 64 patients (60.4%).
• 35 patients had hypoperfusion detected by 3D-ASL despite being DWI-negative, demonstrating complementary value.

Combined 3D-ASL plus DWI imaging improved 90-day stroke prediction compared to either modality alone.

• Combined imaging achieved AUC 0.854, sensitivity 93.8%, and specificity 71.1% for 90-day stroke prediction.
• DWI alone achieved AUC 0.761 and 3D-ASL alone achieved AUC 0.790.
• The improvement of combined imaging over individual modalities was statistically significant (P < .05).
• ROC curve analysis was used to evaluate diagnostic performance.

During 90-day follow-up, 16 TIA patients (15.1%) experienced stroke.

• The stroke incidence was 15.1% (16 out of 106 patients) within 90 days.
• Multivariate Cox regression analysis was used to identify independent predictors of stroke.
• Three independent predictors were identified: DWI positivity, hypoperfusion volume >15 mL, and ABCD2 score ≥4.

DWI positivity, hypoperfusion volume greater than 15 mL, and ABCD2 score ≥4 were independent predictors of 90-day stroke.

• DWI positivity was associated with HR 3.24 (95% CI: 1.18–8.91).
• Hypoperfusion volume >15 mL was associated with HR 2.87 (95% CI: 1.06–7.78).
• ABCD2 score ≥4 was associated with HR 3.01 (95% CI: 1.09–8.31).
• These predictors were identified through multivariate Cox regression analysis.

Symptom duration ≥1 hour was associated with higher DWI positivity rates and larger hypoperfusion volumes.

• DWI positivity was 47.7% in patients with symptom duration ≥1 hour versus 25.8% in those with shorter duration (P = .012).
• Mean hypoperfusion volume was 16.8 mL in patients with symptom duration ≥1 hour versus 9.2 mL in those with shorter duration (P = .004).
• These findings suggest symptom duration is correlated with severity of imaging findings.

Current standard DWI imaging detects only 30% to 50% of TIA-related lesions, motivating the use of complementary hemodynamic imaging.

• DWI sensitivity limitations for TIA are acknowledged as a key diagnostic gap in the background literature.
• 3D-ASL offers complementary hemodynamic assessment to structural DWI findings.
• The study used 3.0T MRI with both DWI and 3D-ASL with dual post-labeling delays to maximize detection.