Wang Jianwei, Zhang Tingxia, Zhou Huan, Yan Shenqiang
Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Department of Neurology, School of Medicine, The 2nd Affiliated Hospital of Zhejiang University, #88 Jiefang Road, Hangzhou, China.
Acta Neurol Belg. 2025 Apr;125(2):311-317. doi: 10.1007/s13760-024-02707-6. Epub 2024 Dec 26.
Ischemic stroke, accounting for approximately 80% of all stroke cases, remains a leading cause of death and disability worldwide. Effective management of ischemic stroke is heavily influenced by its etiology, which can range from large-artery atherosclerosis and cardiac embolism to cerebral small-vessel occlusions and cryptogenic strokes. Cardioembolic stroke, which makes up about 30% of ischemic strokes, often leads to more severe symptoms and worse outcomes, necessitating anticoagulation therapy for prevention. Cryptogenic strokes, comprising over 25% of ischemic strokes, pose significant challenges for treatment and prevention due to their elusive nature. Thorough investigation of cardioembolic sources during the acute phase of stroke is crucial. While transthoracic and transesophageal echocardiography are traditional methods for detecting intracardiac thrombi and patent foramen ovale (PFO), cardiac CT has emerged as a non-invasive, efficient alternative. Cardiac CT can effectively visualize intracardiac thrombi, PFO, valvular abnormalities, tumors, and complex aortic plaques. This review discusses the potential applications of cardiac CT in ischemic stroke, emphasizing its role in identifying stroke etiology, predicting stroke risk, and assessing patient prognosis. The integration of advanced imaging technologies and artificial intelligence further enhances its diagnostic accuracy and clinical utility, promising to improve outcomes and reduce the healthcare burden associated with ischemic stroke.
缺血性中风约占所有中风病例的80%，仍是全球死亡和残疾的主要原因。缺血性中风的有效管理在很大程度上受其病因影响，病因范围从大动脉粥样硬化、心脏栓塞到脑小血管闭塞和隐源性中风。心源性栓塞性中风约占缺血性中风的30%，通常会导致更严重的症状和更差的预后，因此需要进行抗凝治疗以预防。隐源性中风占缺血性中风的25%以上，因其难以捉摸的性质，在治疗和预防方面构成重大挑战。在中风急性期对心源性栓塞源进行全面调查至关重要。虽然经胸和经食管超声心动图是检测心内血栓和卵圆孔未闭（PFO）的传统方法，但心脏CT已成为一种非侵入性、高效的替代方法。心脏CT可以有效地显示心内血栓、PFO、瓣膜异常、肿瘤和复杂的主动脉斑块。本综述讨论了心脏CT在缺血性中风中的潜在应用，强调其在确定中风病因、预测中风风险和评估患者预后方面的作用。先进成像技术与人工智能的结合进一步提高了其诊断准确性和临床实用性，有望改善预后并减轻与缺血性中风相关的医疗负担。
