Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Neurol Neurosurg Psychiatry. 2017 Jan;88(1):31-37. doi: 10.1136/jnnp-2016-314023. Epub 2016 Sep 22.
Stroke of undetermined aetiology or 'cryptogenic' stroke accounts for 30-40% of ischaemic strokes despite extensive diagnostic evaluation. The role and yield of cardiac imaging is controversial. Cardiac MRI (CMR) has been used for cardiac disorders, but its use in cryptogenic stroke is not well established. We reviewed the literature (randomised trials, exploratory comparative studies and case series) on the use of CMR in the diagnostic evaluation of patients with ischaemic stroke. The literature on the use of CMR in the diagnostic evaluation of ischaemic stroke is sparse. However, studies have demonstrated a potential role for CMR in the diagnostic evaluation of patients with cryptogenic stroke to identify potential aetiologies such as cardiac thrombi, cardiac tumours, aortic arch disease and other rare cardiac anomalies. CMR can also provide data on certain functional and structural parameters of the left atrium and the left atrial appendage which have been shown to be associated with ischaemic stroke risk. CMR is a non-invasive modality that can help identify potential mechanisms in cryptogenic stroke and patients who may be targeted for enrolment into clinical trials comparing anticoagulation to antiplatelet therapy in secondary stroke prevention. Prospective studies are needed to compare the value of CMR as compared to transthoracic and transesophageal echocardiography in the diagnostic evaluation of cryptogenic stroke.
不明病因性卒中或“隐源性”卒中占缺血性卒中的 30-40%，尽管进行了广泛的诊断评估。心脏影像学的作用和效果仍存在争议。心脏磁共振成像（CMR）已用于心脏疾病的诊断，但在隐源性卒中中的应用尚未得到充分确立。我们对 CMR 用于缺血性卒中患者诊断评估的文献（随机试验、探索性比较研究和病例系列）进行了回顾。CMR 用于缺血性卒中诊断评估的文献相对较少。然而，研究表明 CMR 在诊断评估隐源性卒中患者方面具有潜在作用，可以识别潜在病因，如心内血栓、心脏肿瘤、主动脉弓疾病和其他罕见的心脏异常。CMR 还可以提供左心房和左心耳某些功能和结构参数的数据，这些参数与缺血性卒中风险相关。CMR 是一种非侵入性的方法，可以帮助确定隐源性卒中的潜在机制，并可能有助于将某些患者纳入临床试验，比较抗凝治疗与抗血小板治疗在二级卒中预防中的效果。需要前瞻性研究来比较 CMR 在隐源性卒中诊断评估中的价值，与经胸超声心动图和经食管超声心动图相比。
