Multicenter Study

. 2025 Mar;27(3):215-220.

doi: 10.1007/s43678-024-00853-7. Epub 2025 Feb 4.

The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke

Matthieu Robitaille¹, Marcel Émond^{2

3}, Mukul Sharma⁴, Ariane Mackey^{2

1}, Pierre-Gilles Blanchard^{2

3}, Marie-Joe Nemnom⁵, Marco L A Sivilotti⁶, Ian G Stiell^{7

5}, Grant Stotts⁸, Jacques Lee^{9

10}, Andrew Worster¹¹, Judy Morris¹², Ka Wai Cheung¹³, Albert Y Jin¹⁴, Demetrios J Sahlas⁴, Heather E Murray⁶, Steve Verreault^{2

1}, Marie-Christine Camden^{2

1}, Samuel Yip¹⁵, Philip Teal¹⁵, David J Gladstone¹⁶, Mark I Boulos¹⁶, Nicolas Chagnon¹⁷, Elizabeth Shouldice¹⁸, Clare Atzema¹⁰, Tarik Slaoui¹², Jeanne Teitlebaum¹², George A Wells⁵, Jeffrey J Perry^{19

20}

Affiliations

¹ Division of Neurology, Laval University, Quebec City, QC, Canada.
² CHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
³ Division of Emergency Medicine, Université Laval, Quebec City, Québec, Canada.
⁴ Division of Neurology, McMaster University, Hamilton, ON, Canada.
⁵ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
⁷ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Schwartz\Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁰ Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹¹ Department of Medicine & Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
¹² Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada.
¹³ University of British Columbia, Vancouver, BC, Canada.
¹⁴ Division of Neurology, Queen's University, Kingston, ON, Canada.
¹⁵ Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre & Division of Neurology, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of Emergency Medicine, Montfort Hospital and University of Ottawa, Ottawa, ON, Canada.
¹⁸ Queensway Carleton Hospital and University of Ottawa, Ottawa, ON, Canada.
¹⁹ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. jperry@ohri.ca.
²⁰ Ottawa Hospital Research Institute, Ottawa, ON, Canada. jperry@ohri.ca.

PMID: 39903424
DOI: 10.1007/s43678-024-00853-7

Multicenter Study

The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke

Matthieu Robitaille et al. CJEM. 2025 Mar.

. 2025 Mar;27(3):215-220.

doi: 10.1007/s43678-024-00853-7. Epub 2025 Feb 4.

Authors

Affiliations

¹ Division of Neurology, Laval University, Quebec City, QC, Canada.
² CHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Québec, Canada.
³ Division of Emergency Medicine, Université Laval, Quebec City, Québec, Canada.
⁴ Division of Neurology, McMaster University, Hamilton, ON, Canada.
⁵ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
⁷ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Schwartz\Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁰ Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹¹ Department of Medicine & Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
¹² Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Québec, Canada.
¹³ University of British Columbia, Vancouver, BC, Canada.
¹⁴ Division of Neurology, Queen's University, Kingston, ON, Canada.
¹⁵ Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre & Division of Neurology, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of Emergency Medicine, Montfort Hospital and University of Ottawa, Ottawa, ON, Canada.
¹⁸ Queensway Carleton Hospital and University of Ottawa, Ottawa, ON, Canada.
¹⁹ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. jperry@ohri.ca.
²⁰ Ottawa Hospital Research Institute, Ottawa, ON, Canada. jperry@ohri.ca.

PMID: 39903424
DOI: 10.1007/s43678-024-00853-7

Abstract
in English, French

Background: Diffusion weighted magnetic resonance imaging's (MRI) role in predicting subsequent strokes beyond the validated Canadian TIA Score in in transient ischemic attack (TIA)/minor stroke patients with normal CT scans is unknown. In this study, we assessed the incidence of acute cerebral infarction on MRI in these patients, overall and stratified by the Canadian TIA Score levels and then we assessed subsequent stroke rates at 7, 30 and 90 days based on the presence of acute infarct on MRI.

Methods: This pre-planned substudy of the Canadian TIA risk score cohort was conducted across 13 Canadian emergency departments over an 11-year period. Eligible patients included adult TIA/minor stroke patients with negative CT scans who underwent MRI within 7 days.

Results: Among 11,507 patients, 1048 with negative CT scans had early MRI, which revealed infarction in 330 (31.5%) patients. Acute infarction rates varied by Canadian TIA Score risk group: 130 (15.4%) in low-risk, 754 (30.4%) in medium-risk, and 162 (50.0%) in the high-risk group. At 90 days, the rates of stroke in patients with a positive MRI were 2 (10.0%), 168 (22.3%), and 40 (24.7%) in low-risk, medium-risk, and high-risk groups, respectively. In comparison, in patients with a negative MRI the rate was 1 (0.9%), 7 (1.3%), and 4 (4.9%).

Conclusions: Combining the Canadian TIA Risk Score with follow-up MRI improves stroke risk assessment. MRI enhance the accuracy of diagnosis TIA, especially when CT is negative. The risk score helps prioritize MRI, benefiting medium-risk patients most, while high-risk patients need prompt management regardless of MRI results. Low-risk patients benefit from MRI for determining further investigations.

RéSUMé: CONTEXTE: On ne connaît pas le rôle de l’imagerie par résonance magnétique (IRM) pondérée en diffusion dans la prédiction des accidents vasculaires cérébraux ultérieurs au-delà du score canadien validé du TIA chez les patients atteints d’un accident ischémique transitoire (AIT)/AVC mineur avec tomodensitométrie normale. Dans cette étude, nous avons évalué l’incidence de l’infarctus cérébral aigu parIRM chez ces patients, globalement et stratifiée selon les niveaux du score canadien de TIA, puis nous avons évalué les taux d’accidents vasculaires cérébraux subséquents à 7, 30 et 90 jours en fonction de la présence d’un infarctus aigu sur l’IRM. MéTHODES: Cette sous-étude préplanifiée de la cohorte canadienne des cotes de risque du TIA a été menée auprès de 13 services d’urgence canadiens sur une période de 11 ans. Les patients admissibles comprenaient des patients adultes atteints d’AIT/AVC mineur avec des résultats négatifs à la tomodensitométrie qui ont subi une IRM dansun délai de sept jours. RéSULTATS: Parmi 11507 patients, 1048 avec des résultats de tomodensitométrie négatifs ont subi une IRM précoce, ce qui a révélé un infarctus chez 330 patients (31,5 %). Les taux d’infarctus aigus variaient selon le groupe de risque du Canadian TIA Score: 130 (15,4 %) dans le groupe à faible risque, 754 (30,4 %) dans le groupe à risque moyen et 162 (50,0 %) dans le groupe à risque élevé. À 90 jours, les taux d’AVC chez les patients ayant une IRM positive étaient de 2 (10,0 %), 168 (22,3 %) et 40 (24,7 %) dans les groupes à faible risque, à risque moyen et à risque élevé, respectivement. En comparaison, chez les patients ayant une IRM négative, le taux était de 1 (0,9 %), 7 (1,3 %) et 4 (4,9 %). CONCLUSIONS: La combinaison du TIA Canadian Score avec l’IRM de suivi améliore l’évaluation des risques d’AVC. IRM améliore la précision du diagnostic de l’AIT, en particulier lorsque la tomodensitométrieest négatif. Le score de risque aide à prioriser l’IRM, ce qui profite surtout aux patients à risque moyen, tandis que les patients à risque élevé ont besoin d’une prise en charge rapide, indépendamment des résultats de l’IRM. Les patients à faible risque bénéficient de l’IRM pour déterminer d’autres investigations.

Keywords: Diffusion magnetic resonance imaging; Ischemic attack; Stroke.

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Conflict of interest statement

Declarations. Conflict of interest: Jeffrey Perry and Clare Atzema are supported by a peer-reviewed Mid-Career Salary Support Award from the Heart and Stroke Foundation of Ontario. The authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted; and any discrepancies from the study as planned (and, if relevant, registered) have been explained.

References

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1. Perry JJ, Sivilotti MLA, Émond M, Stiell IG, Stotts G, Lee J, et al. Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study. BMJ. 2021;4: n49. - DOI
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The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke

Affiliations

The value of MRI in transient ischemic attack/minor stroke following a negative CT for predicting subsequent stroke

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Abstract in English, French

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Abstract
in English, French