Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin
Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin
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DOI：
10.1161/strokeaha.116.016227
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发表时间：
2017-05-01
期刊：
影响因子：
8.3
通讯作者：
Fiebach, Jochen B.
中科院分区：
文献类型：
--
作者：
Haeusler, Karl Georg;Wollboldt, Christian;Fiebach, Jochen B.
背景和目的--在经过最先进的诊断工作后，约25%的急性缺血性卒中的病因仍未确定(不明原因)。方法：103名经磁共振成像(MRI)证实的原因不明的急性缺血性卒中患者在接受包括经食道超声心动图(TEE)在内的最新诊断工作的同时，还接受了3-T心脏磁共振和主动脉弓磁共振血管成像检查。结果：102例(99.0%)缺血性卒中患者(中位数63岁[四分位数范围，53-72岁]，24%女性，入院时NIHSS评分中位数[四分位数范围1-4])在医院接受了cvMRI和TEE检查，89例(86.4%)完成了cvMRI检查。93例不明原因卒中患者中，cvMRI发现高危栓塞源9例(8.7%)，超声心动图发现高危栓塞源11例(11.8%)。CvMRI和超声心动图的结果符合80例(86.0%)，符合程度为kappa=0.24。在82例不明原因卒中患者中，根据常规检查，包括TEE，cvMRI确定了另外5例(6.1%)卒中的病因。在接受cvMRI检查的卒中患者中，13例(14.6%)出现了与既往心肌梗死相一致的晚期Gd强化。这13名患者中只有2名已知冠状动脉疾病。结论--我们的研究表明，cvMRI在纳入的绝大多数急性缺血性卒中患者中是可行的。CvMRI的诊断信息似乎是对TEE的补充，但不能取代急性缺血性卒中后的超声心动图。
Background and Purpose-Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up.Methods-One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke.Results-Overall, 102 (99.0%) ischemic stroke patients (median 63 years [interquartile range, 53-72], 24% female, median NIHSS (National Institutes of Health Stroke Scale) score on admission 2 [interquartile range, 1-4]) underwent cvMRI and TEE in hospital; 89 (86.4%) patients completed the cvMRI examination. In 93 cryptogenic stroke patients, a high-risk embolic source was found in 9 (8.7%) patients by cvMRI and in 11 (11.8%) patients by echocardiography, respectively. cvMRI and echocardiography findings were consistent in 80 (86.0%) patients, resulting in a degree of agreement of kappa= 0.24. In 82 patients with cryptogenic stroke according to routine work-up, including TEE, cvMRI identified stroke etiology in additional 5 (6.1%) patients. Late gadolinium enhancement consistent with previous myocardial infarction was found in 13 (14.6%) out of 89 stroke patients completing cvMRI. Only 2 of these 13 patients had known coronary artery disease.Conclusions-Our study demonstrated that cvMRI was feasible in the vast majority of included patients with acute ischemic stroke. The diagnostic information of cvMRI seems to be complementary to TEE but is not replacing echocardiography after acute ischemic stroke.