Ischemic stroke: etiologic work-up with multidetector CT of heart and extra- and intracranial arteries.
OBJECTIVE
To assess the potential of a single-session multidetector computed tomography (CT) protocol, as compared with established methods, for the etiologic work-up of acute ischemic stroke.


METHODS
Patients found to have recently experienced an ischemic stroke were recruited for this prospective study after institutional review board approval was obtained. Each patient was scheduled for two evaluation strategies: (a) a standard approach involving transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), duplex ultrasonography (US) of the neck vessels, and magnetic resonance (MR) angiography of the neck and brain vessels; and (b) a protocol involving single-session multidetector CT of the heart, neck, and brain vessels. The authors sought to determine the major etiologic factors of stroke, including cardiac sources of embolism and atheroma of the aortic arch and the extra- and intracranial vessels, by using both strategies.


RESULTS
Multidetector CT, MR imaging, and duplex US were performed in 46 patients, 39 of whom also underwent TEE. The sensitivity and specificity of multidetector CT were 72% (18 of 25 cases) and 95% (20 of 21 cases), respectively, for detection of cardiac sources and 100% (24 of 24 cases) and 91% (20 of 22 cases), respectively, for detection of major arterial atheroma. For the 46 cases of stroke, the final etiologic classifications determined by using the standard combination approach were cardiac sources in 20 (44%) cases, major arterial atheroma in nine (20%), multiple sources in four (9%), and cryptogenic sources in 13 (28%). Multidetector CT facilitated correct etiologic classification for 38 (83%) of the 46 patients.


CONCLUSIONS
Multidetector CT is a promising tool for etiologic assessment of ischemic stroke, although the identification of minor cardiac sources with this examination requires the establishment of robust criteria.
Department of Radiology, Louis Pradel Hospital, 28 Av Doyen Lepine, 69500 Bron, France. loic.boussel@gmail.com
Loic
L
Boussel
Serkan
S
Cakmak
Max
M
Wintermark
Norbert
N
Nighoghossian
Romaric
R
Loffroy
Philippe
P
Coulon
Laurent
L
Derex
Tae Hee
TH
Cho
Philippe C
PC
Douek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol