Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Cardiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Brain Behav. 2020 Jun;10(6):e01620. doi: 10.1002/brb3.1620. Epub 2020 Apr 18.
Despite a thorough work-up including transesophageal echocardiography, 20%-30% of stroke etiology remains cryptogenic. Transesophageal echocardiogram is considered the gold standard procedure to detect cardiac or aortic sources of emboli. In the recent years, cardiovascular MRI has emerged as a noninvasive, sound, and reliable modality to image morphological and functional abnormalities. In this study, we compared none contrast cardiovascular MRI to transesophageal echocardiogram, in the ability to detect cardiovascular source of embolus in cryptogenic ischemic strokes.
A series of 24 patients who were labeled, after a thorough stroke work-up, as having cryptogenic stroke, were examined with both transesophageal echocardiogram and noncontrast cardiovascular MRI to assess for cardiac or aortic source of emboli. The cardiologist who interpreted the transesophageal echocardiograms was blinded to the results of cardiovascular MRI. At the same time, the radiologist who interpreted the cardiovascular MRI was also blinded to the results of transesophageal echocardiogram. The cardiac lesions, with potential source of emboli that were assessed in our study included left ventricular thrombus, atrial septal aneurysm, and aortic atherosclerotic disease. The ability of cardiovascular MRI to identify potential source of cardiac embolus was then compared to that of transesophageal echocardiogram.
Transesophageal echocardiogram detected ascending or arch aortic atherosclerotic plaque in 14 of the 24 patients. Other abnormalities detected include two atrial septal aneurysms and two left ventricular thrombus. Cardiovascular MRI was able to identify aortic atheroma in 13 patients; as well as three atrial septal aneurysms and two left ventricular thrombus. The accuracy of cardiovascular MRI to detect aortic atheroma, atrial septal aneurysm or left ventricular thrombus was great; 96%, 95.83%, and 100%, respectively.
This small study suggests that, in patients with cryptogenic stroke, cardiovascular MRI is comparable to transesophageal echocardiogram in detecting cardiac and aortic source of emboli.
尽管进行了全面的检查，包括经食管超声心动图，但仍有 20%-30%的中风病因是隐匿性的。经食管超声心动图被认为是检测心内或主动脉栓子来源的金标准程序。近年来，心血管磁共振成像已成为一种非侵入性、可靠的成像方式，可用于检测形态和功能异常。在这项研究中，我们将比较非对比心血管磁共振成像与经食管超声心动图，以检测隐匿性缺血性中风的心血管栓子来源。
对经过全面的中风检查后被标记为隐匿性中风的 24 例患者进行了一系列检查，这些患者同时接受了经食管超声心动图和非对比心血管磁共振成像检查，以评估心内或主动脉栓子的来源。解读经食管超声心动图的心脏病专家对心血管磁共振成像的结果不知情。同时，解读心血管磁共振成像的放射科医生也对经食管超声心动图的结果不知情。在我们的研究中，评估的潜在心源性栓子来源的心脏病变包括左心室血栓、房间隔瘤和主动脉粥样硬化病变。然后将心血管磁共振成像识别潜在心源性栓子来源的能力与经食管超声心动图进行比较。
经食管超声心动图在 24 例患者中的 14 例中检测到升主动脉或弓部主动脉粥样硬化斑块。其他检测到的异常包括两个房间隔瘤和两个左心室血栓。心血管磁共振成像能够在 13 例患者中识别主动脉粥样硬化；以及三个房间隔瘤和两个左心室血栓。心血管磁共振成像检测主动脉粥样硬化、房间隔瘤或左心室血栓的准确性很高，分别为 96%、95.83%和 100%。
这项小型研究表明，在隐匿性中风患者中，心血管磁共振成像在检测心内和主动脉栓子来源方面与经食管超声心动图相当。
