Department of Neuroradiological Intervention and Diagnostics, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Clin Neuroradiol. 2021 Dec;31(4):911-920. doi: 10.1007/s00062-021-01003-7. Epub 2021 Mar 10.
Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up.
Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up.
In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES.
These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.
复发性中风被认为会增加严重残疾和死亡的发生率。为了正确评估风险和进行患者管理，早期识别中风的病因至关重要。经胸超声心动图（TTE）是评估疑似心源性中风（CES）患者的初始标准护理方法，但诊断能力有限。经食管超声心动图（TEE）被认为是金标准；然而，这种方法耗时、半侵入性且并非总是可行。我们假设在初始多模态 CT 基础上增加延迟相心脏 CT（cCT）可能是替代常规临床超声心动图检查的有效方法。
纳入经初始多模态 CT 证实为疑似急性心源性中风且随后接受 cCT 检查的患者。评估 cCT 是否存在主要 CES，并与常规临床超声心动图检查进行比较。
共有 102 例疑似急性 CES 的患者接受了 cCT 检查。其中 60 例行常规检查，包括超声心动图（50 例行 TTE，仅 10 例行 TEE）。cCT 发现 10/60（16.7%）例主要 CES，但仅通过超声心动图发现 4/60（6.7%）例。超声心动图观察到的所有 CES 也均通过 cCT 发现。在未行超声心动图检查的 36 例患者中，cCT 也发现了 8 例主要 CES。
这些初步结果显示延迟相 cCT 检测主要 CES 的潜在诊断效能，从而可以加速决策以预防中风复发。为了证实这些结果，需要进行更大规模的研究，以 TEE 作为参考标准，并与 TTE 进行比较。
