Department of Neurology, Seoul National University Hospital, Seoul, Korea.
Cerebrovasc Dis. 2010;29(4):313-20. doi: 10.1159/000278926. Epub 2010 Jan 30.
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.
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.
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.
Cardiac MDCT is a feasible and accurate diagnostic tool for embolic sources in an acute stroke setting.
心脏多层螺旋 CT（MDCT）对患者状况的依赖性较低，在因神经功能缺损而导致患者配合受限的情况下，对于诊断栓塞源可能具有重要价值。然而，其在假定为栓塞性卒中机制的急性卒中患者中的作用尚未得到验证。
本研究纳入了 2007 年 5 月 1 日至 2007 年 11 月 30 日期间因急性缺血性卒中入院的连续患者。纳入标准为：（1）存在任何提示心源性高风险栓塞源的证据，（2）存在影像学或（3）提示栓塞性卒中的临床证据。所有患者均首先接受经胸超声心动图检查，然后尝试进行心脏 MDCT 或经食管超声心动图（TEE）检查。比较了心脏 MDCT 和 TEE 的结果和可行性。
143 例患者符合纳入标准。124 例患者（86.7%）进行了心脏 MDCT 检查，83 例患者（57.3%）进行了 TEE 检查，而 75 例患者（52.4%）同时进行了这两项检查。心脏 MDCT 检查的主要阻碍因素为肾功能不全，TEE 检查的主要阻碍因素为缺乏合作。在同时进行这两项检查的患者中，心脏 MDCT 检查发现 8 例存在高危心内源性栓塞源，20 例存在心外源性栓塞源，而 TEE 检查发现 1 例存在心内源性栓塞源，7 例存在心外源性栓塞源。在检测心源性栓塞源和高危主动脉粥样硬化方面，心脏 MDCT 检查具有统计学显著差异。
心脏 MDCT 是急性卒中患者诊断栓塞源的一种可行且准确的诊断工具。
