Role of Cardiac Multidetector Computed Tomography in Acute Ischemic Stroke: A Preliminary Report

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background and Purpose: Cardiac multidetector computed tomography (MDCT) is less dependent upon the patient’s condition and may be valuable in the diagnosis of embolic sources when the patient’s cooperation is limited due to a neurologic deficit. However, its role has never been validated in acute stroke patients whose stroke mechanism is assumed to be embolic. Methods: Consecutive patients who were admitted with acute ischemic stroke from May 1, 2007 to November 30, 2007 were included in this study. Inclusion criteria were (1) any cardiac evidence of high-risk embolic sources for cerebral embolism, or (2) radiological or (3) clinical evidence of embolic stroke. All patients underwent transthoracic echocardiography first, and then cardiac MDCT or transesophageal echocardiography (TEE) was attempted, if possible. The results and feasibility of cardiac MDCT and TEE were compared. Results: One hundred and forty-three patients met the inclusion criteria. Cardiac MDCT was performed in 124 patients (86.7%), TEE in 83 patients (57.3%), whereas 75 patients (52.4%) underwent both studies. Renal insufficiency for cardiac MDCT and lack of cooperation for TEE were found to be the most impeding factors. Among the patients with both evaluations, cardiac MDCT identified a high-risk intracardiac embolic source in 8 and an extracardiac source in 20, while TEE found an intracardiac source in 1 and an extracardiac source in 7. Statistically significant differences were found with respect to detecting cardioembolic sources and high-risk aortic atheroma. Conclusions: Cardiac MDCT is a feasible and accurate diagnostic tool for embolic sources in an acute stroke setting.

Related collections

Most cited references 24

Record: found
Abstract: found
Article: not found

Atherosclerotic disease of the aortic arch and the risk of ischemic stroke.

P Amarenco, G Besson, M Hommel … (1994)

Atherosclerotic disease of the aortic arch has been suspected to be a potential source of cerebral emboli. We conducted a study to quantify the risk of ischemic stroke associated with atherosclerotic disease of the aortic arch. Using transesophageal echocardiography, we performed a prospective case-control study of the frequency and thickness of atherosclerotic plaques in the ascending aorta and proximal arch in 250 consecutive patients admitted to the hospital with ischemic stroke and 250 consecutive controls, all over the age of 60 years. Atherosclerotic plaques > or = mm in thickness were found in 14.4 percent of the patients but in only 2 percent of the controls. After adjustment for atherosclerotic risk factors, the odds ratio for ischemic stroke among patients with such plaques was 9.1 (95 percent confidence interval, 3.3 to 25.2; P or = 4 mm in thickness, as compared with 8.1 percent of the 172 patients who had infarcts whose possible or likely causes were known (odds ratio, 4.7; 95 percent confidence interval, 2.2 to 10.1; P or = 4 mm in the aortic arch were not associated with the presence of atrial fibrillation or stenosis of the extracranial internal carotid artery. In contrast, plaques that were 1 to 3.9 mm thick were frequently associated with carotid stenosis of > or = 70 percent. These results indicate a strong, independent association between atherosclerotic disease of the aortic arch and the risk of ischemic stroke. The association was particularly strong with thick plaques. Atherosclerotic disease of the aortic arch should be regarded as a risk factor for ischemic stroke and as a possible source of cerebral emboli.

0 comments Cited 124 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings.

Thomas Schertler, Florian Wolf, André Plass … (2009)

The aim of this study was to assess the value of multislice computed tomography (CT) for the assessment of valvular abnormalities in patients with infective endocarditis (IE) in comparison with transesophageal echocardiography (TEE) and intraoperative findings. Multislice CT has recently shown promising data regarding valvular imaging in a 4-dimensional fashion. Thirty-seven consecutive patients with clinically suspected IE were examined with TEE and 64-slice CT or dual-source CT. Twenty-nine patients had definite IE and underwent surgery. The diagnostic performance of CT for the detection of evident valvular abnormalities for IE compared with TEE was: sensitivity 97%, specificity 88%, positive predictive value (PPV) 97%, and negative predictive value (NPV) 88% on a per-patient basis (n = 37; excellent intermodality agreement kappa = 0.84). CT correctly identified 26 of 27 (96%) patients with valvular vegetations and 9 of 9 (100%) patients with abscesses/pseudoaneurysms compared with the intraoperative specimen. On a per-valve-based analysis, diagnostic accuracy for the detection of vegetations and abscesses/pseudoaneurysms compared with surgery was: sensitivity 96%, specificity 97%, PPV 96%, NPV 97%, and sensitivity 100%, specificity 100%, PPV 100%, NPV 100%, respectively, without significant differences as compared with TEE. Vegetation size measurements by CT correlated (r = 0.95; p <0.001) with TEE (mean 7.6 +/- 5.6 mm). The mobility of vegetations was accurately diagnosed in 21 of 22 (96%) patients with CT, but all of 4 leaflet perforations (

0 comments Cited 94 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes.

Dong-Wha Kang, Julio A Chalela, Mustapha Ezzeddine … (2003)

Different topographic patterns in patients who experience an acute ischemic stroke may be related to specific stroke causes. To determine if lesion patterns on early diffusion-weighted imaging (DWI) are associated with stroke subtypes determined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Cross-sectional study. General community hospital. Patients We studied 172 consecutive ischemic stroke patients with a symptomatic lesion on DWI performed within 24 hours of stroke onset. Lesion patterns on DWI were classified into single lesions (corticosubcortical, cortical, subcortical > or =15 mm, or subcortical <15 mm), scattered lesions in one vascular territory (small scattered lesions or confluent with additional lesions), and multiple lesions in multiple vascular territories (in the unilateral anterior circulation, in the posterior circulation, in bilateral anterior circulations, or in anterior and posterior circulations). We found an overall significant relationship between DWI lesion patterns and TOAST stroke subtypes (P<.001). Corticosubcortical single lesions (P =.01), multiple lesions in anterior and posterior circulations (P =.03), and multiple lesions in multiple cerebral circulations (P =.008) were associated with cardioembolism. Multiple lesions in the unilateral anterior circulation (P =.04) and small scattered lesions in one vascular territory (P =.06) were related to large-artery atherosclerosis. Nearly half (11/23) of the patients with a single subcortical lesion that was 15 mm or larger were classified as having cryptogenic strokes (P =.001), although 9 of these patients had a classic lacunar syndrome without cortical hypoperfusion. Early DWI lesion patterns are associated with specific stroke causes. Conventional 15-mm criteria for lacunes, however, may underestimate the diagnosis of small-vessel occlusion with DWI.

0 comments Cited 67 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (publisher-id): CED

Journal ID (nlm-ta): Cerebrovasc Dis

Journal ID (doi): 10.1159/issn.1015-9770

Title: Cerebrovascular Diseases

Publisher: S. Karger AG

ISSN (Print): 1015-9770

ISSN (Electronic): 1421-9786

Publication date Subscription-year: 2010

Publication date (Print): March 2010

Publication date (Electronic): 30 January 2010

Volume: 29

Issue: 4

Pages: 313-320

Affiliations

^aDepartment of Neurology, Seoul National University Hospital, and Departments of ^bRadiology, ^cInternal Medicine and ^dNeurology,Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seoul, and ^eDepartment of Biostatistics, College of Medicine, Korea University, Seongnam-si, Korea

Article

Publisher ID: 278926 Other ID: Cerebrovasc Dis 2010;29:313–320

DOI: 10.1159/000278926

PubMed ID: 20130396

SO-VID: 96f9d62c-63a9-47cd-b209-1652b832abc4

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 12 May 2009

Date accepted : 13 October 2009

Page count

Figures: 1, Tables: 3, References: 31, Pages: 8

Comments

Comment on this article

scite_

Cited by 6

See all cited by

Most referenced authors 424

See all reference authors

- Version 1

Call for Papers: Sex and Gender in Neurodegenerative Diseases

Submit here before September 30, 2024

Role of Cardiac Multidetector Computed Tomography in Acute Ischemic Stroke: A Preliminary Report

Read this article at

Abstract

Related collections

Karger: Neurology and Neuroscience

Most cited references 24

Atherosclerotic disease of the aortic arch and the risk of ischemic stroke.

Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings.

Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes.

Author and article information

Journal

Affiliations

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 209

Cited by 6

Most referenced authors 424