Early Diffusion Weighted MRI as a Negative Predictor for Disabling Stroke After ABCD2 Score Risk Categorization in Transient Ischemic Attack Patients

Background and Purpose-The prognostic value early diffusion-weighted magnetic resonance imaging (DWMRI) adds in the setting of transient ischemic attack (TIA), after risk stratification by a clinical score, is unclear. The purpose of this study is to evaluate, after ABCD(2) score risk categorization in admitted TIA patients, whether negative DWMRI performed within 24 hours of symptom onset improves on the identification of patients at low risk for experiencing a disabling stroke within 90 days. Methods-At 15 North Carolina hospitals, we enrolled a prospective nonconsecutive sample of admitted TIA patients. We excluded patients not undergoing a DWMRI within 24 hours of admission and patients for whom a dichotomized (<= or > 3) ABCD(2) score could not be calculated. We conducted a medical record review to determine disabling ischemic stroke outcomes within 90 days. Results-Over 35 months, 944 TIA patients met inclusion criteria, of whom 4% (n = 41) had a disabling ischemic stroke within 90 days. In analyses stratified by low versus moderate/high ABCD(2) score, the combination of a low risk ABCD(2) score and a negative early DWMRI had excellent sensitivity (100%, 95% CI 34 to 100) for identifying low-risk patients. In patients classified as moderate to high risk, a negative early DWMRI predicted a low risk of disabling ischemic stroke within 90 days (sensitivity 92%, 95% CI 80 to 97; NLR 0.11, 95% CI 0.04 to 0.32). Conclusions-After risk stratification by the ABCD(2) score, early DWMRI enhances the prediction of a low risk for disabling ischemic stroke within 90 days. Further study is warranted in a large, consecutive TIA population of early DWMRI as a sensitive negative predictor for disabling stroke within 90 days. (Stroke. 2009;40:3252-3257.)