{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:51:01Z","timestamp":1760057461663,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Transient ischemic attack (TIA) is a recognized precursor of stroke that also indicates a high risk of recurrence. The Hyperintense Acute Reperfusion Marker (HARM), which is linked to blood\u2013brain barrier disruption, may serve as a novel imaging biomarker for TIA. Methods: A retrospective cohort study of 715 patients with TIA evaluated the predictive value of HARM for stroke recurrence and its association with TOAST subtype. Imaging findings, including those of diffusion-weighted imaging, were analyzed using logistic regression. Results: HARM-positive patients had significantly higher recurrence rates at 3 months (20.9%; odds ratio [OR] = 5.3) and 1 year (30.2%; OR = 5.8) compared to HARM-negative patients, relative to other imaging markers (p &lt; 0.001). HARM was significantly associated with the cardioembolic stroke (p &lt; 0.001). Conclusions: HARM is a promising imaging biomarker for predicting stroke recurrence and etiology in patients experiencing TIA. Incorporating HARM into clinical frameworks may enhance diagnostic and prognostic accuracy.<\/jats:p>","DOI":"10.3390\/brainsci15020170","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T04:44:03Z","timestamp":1739162643000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictive Value of Hyperintense Acute Reperfusion Marker in Transient Ischemic Attacks: Stroke Recurrence and TOAST Classification"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-1760","authenticated-orcid":false,"given":"Sang-Hoon","family":"Han","sequence":"first","affiliation":[{"name":"Naval Maritime Medical Center, Changwon 51640, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9815-7652","authenticated-orcid":false,"given":"Kyu-Sun","family":"Yum","sequence":"additional","affiliation":[{"name":"Chungbuk National University College of Medicine, Department of Neurology, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1159\/000441098","article-title":"Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20\u201364 Years in 1990\u20132013: Data from the Global Burden of Disease 2013 Study","volume":"45","author":"Krishnamurthi","year":"2015","journal-title":"Neuroepidemiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e036142","DOI":"10.1161\/JAHA.124.036142","article-title":"Projections of the Stroke Burden at the Global, Regional, and National Levels up to 2050 Based on the Global Burden of Disease Study 2021","volume":"13","author":"Cheng","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S0140-6736(20)30677-2","article-title":"Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: A forecasting analysis for the Global Burden of Disease Study","volume":"396","author":"Vollset","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kuriakose, D., and Xiao, Z. (2020). Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21207609"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1001\/jama.2020.25071","article-title":"Incidence of Transient Ischemic Attack and Association with Long-term Risk of Stroke","volume":"325","author":"Lioutas","year":"2021","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1161\/STROKEAHA.107.505438","article-title":"Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke","volume":"39","author":"Ois","year":"2008","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s12974-022-02467-1","article-title":"Interleukin-6 and YKL-40 predicted recurrent stroke after ischemic stroke or TIA: Analysis of 6 inflammation biomarkers in a prospective cohort study","volume":"19","author":"Li","year":"2022","journal-title":"J. Neuroinflammation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0140-6736(05)66702-5","article-title":"A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack","volume":"366","author":"Rothwell","year":"2005","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ildstad, F., Ellekj\u00e6r, H., Wethal, T., Lydersen, S., Sund, J.K., Fj\u00e6rtoft, H., Sch\u00fcler, S., Horn, J.W., Br\u00e5then, G., and Midts\u00e6ther, A.G. (2019). Stroke risk after transient ischemic attack in a Norwegian prospective cohort. BMC Neurol., 19.","DOI":"10.1186\/s12883-018-1225-y"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1161\/STROKEAHA.111.680033","article-title":"Early magnetic resonance imaging in transient ischemic attack and minor stroke: Do it or lose it","volume":"44","author":"Moreau","year":"2013","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1161\/STROKEAHA.108.515817","article-title":"DWI lesions and TIA etiology improve the prediction of stroke after TIA","volume":"40","author":"Calvet","year":"2009","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.12.023","article-title":"Prevalence of positive diffusion-weighted imaging findings and ischemic stroke recurrence in transient ischemic attack","volume":"24","author":"Gon","year":"2015","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1161\/STROKEAHA.106.475541","article-title":"Diffusion-weighted imaging-negative patients with transient ischemic attack are at risk of recurrent transient events","volume":"38","author":"Boulanger","year":"2007","journal-title":"Stroke"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e033817","DOI":"10.1161\/JAHA.123.033817","article-title":"Magnetic Resonance Imaging Assists with Determining Etiology After Transient Ischemic Attack or Minor Stroke","volume":"13","author":"Moores","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1212\/WNL.0000000000004120","article-title":"Diagnosis of DWI-negative acute ischemic stroke: A meta-analysis","volume":"89","author":"Edlow","year":"2017","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Gorey, S., McCabe, J.J., and Kelly, P.J. (2023). Inflammation\u2014The new treatment target for ischaemic stroke prevention. Front. Stroke, 2.","DOI":"10.3389\/fstro.2023.1241506"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e00516","DOI":"10.1016\/j.neurot.2024.e00516","article-title":"Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging","volume":"22","author":"Sasannia","year":"2025","journal-title":"Neurotherapeutics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"131","DOI":"10.5853\/jos.2014.16.3.131","article-title":"Magnetic resonance imaging in acute ischemic stroke treatment","volume":"16","author":"Kim","year":"2014","journal-title":"J. Stroke"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1161\/STROKEAHA.111.632356","article-title":"The hyperintense acute reperfusion marker on fluid-attenuated inversion recovery magnetic resonance imaging is caused by gadolinium in the cerebrospinal fluid","volume":"43","author":"Struffert","year":"2012","journal-title":"Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1212\/WNL.0b013e318236ef46","article-title":"Hyperacute injury marker (HARM) in primary hemorrhage: A distinct form of CNS barrier disruption","volume":"77","author":"Kidwell","year":"2011","journal-title":"Neurology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1212\/WNL.0000000000001587","article-title":"Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis","volume":"85","author":"Absinta","year":"2015","journal-title":"Neurology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"F\u00f6rster, A., Wenz, H., B\u00f6hme, J., Al-Zghloul, M., and Groden, C. (2016). Hyperintense Acute Reperfusion Marker on FLAIR in Posterior Circulation Infarction. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157738"},{"key":"ref_23","first-page":"9829823","article-title":"Hyperintense Acute Reperfusion Marker on FLAIR in a Patient with Transient Ischemic Attack","volume":"2016","author":"Wenz","year":"2016","journal-title":"Case Rep. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Liu, C., Shi, F., Chen, Z., Yan, S., Ding, X., and Lou, M. (2018). Severe Blood-Brain Barrier Disruption in Cardioembolic Stroke. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00055"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1161\/01.STR.30.6.1174","article-title":"Diffusion MRI in patients with transient ischemic attacks","volume":"30","author":"Kidwell","year":"1999","journal-title":"Stroke"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Choi, H.Y., Lee, K.M., Kim, H.G., Kim, E.J., Choi, W.S., Kim, B.J., Heo, S.H., and Chang, D.I. (2017). Role of Hyperintense Acute Reperfusion Marker for Classifying the Stroke Etiology. Front. Neurol., 8.","DOI":"10.3389\/fneur.2017.00630"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lee, J.Y., Lee, K.M., Kim, H.-G., Woo, H.-G., Lee, J.S., and Kim, E.J. (2021). The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients. Diagnostics, 11.","DOI":"10.3390\/diagnostics11112161"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s11604-017-0615-1","article-title":"Temporal evolution of the signal intensity of hyper-acute ischemic lesions in a canine stroke model: Influence of hyperintense acute reperfusion marker","volume":"35","author":"Xu","year":"2017","journal-title":"Jpn. J. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1002\/ana.20617","article-title":"An evidence-based causative classification system for acute ischemic stroke","volume":"58","author":"Ay","year":"2005","journal-title":"Ann. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1161\/STROKEAHA.108.537969","article-title":"The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients","volume":"40","author":"Purroy","year":"2009","journal-title":"Stroke"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1212\/WNL.52.9.1784","article-title":"Normal diffusion-weighted MRI during stroke-like deficits","volume":"52","author":"Ay","year":"1999","journal-title":"Neurology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/S1474-4422(07)70274-0","article-title":"Risk of stroke early after transient ischaemic attack: A systematic review and meta-analysis","volume":"6","author":"Giles","year":"2007","journal-title":"Lancet Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3988\/jcn.2017.13.2.129","article-title":"Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack","volume":"13","author":"Lee","year":"2017","journal-title":"J. Clin. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1056\/NEJMoa1412981","article-title":"One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke","volume":"374","author":"Amarenco","year":"2016","journal-title":"New Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1001\/archinte.167.22.2417","article-title":"Early risk of stroke after transient ischemic attack: A systematic review and meta-analysis","volume":"167","author":"Wu","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"54","DOI":"10.2174\/157340312801215791","article-title":"Acute cardioembolic cerebral infarction: Answers to clinical questions","volume":"8","author":"Arboix","year":"2012","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1017\/S0317167100000421","article-title":"Biphasic opening of the blood-brain barrier following transient focal ischemia: Effects of hypothermia","volume":"26","author":"Huang","year":"1999","journal-title":"Can. J. Neurol. 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