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Stroke etiological assessment

Abstract
Philips CT Clinical Science Philips Healthcare

Douek P

GHE - Hopital Louis Pradel

 

Background and Purpose

Multi-detector row CT (MSCT) is a powerful tool, allowing one time morphological examination of the heart, and the coronary, cervical and brain arteries. In the setting of stroke, it may simplify etiological screening by avoiding multiples examinations. We evaluated the ability of a one-time cardiac, supra aortic and cerebro vascular CT in establishing the etiology of acute ischemic stroke in comparison with standard screening methods.

 

Methods

In a prospective comparative study, approved by the local Ethical Committee, each patient underwent 2 strategies for the etiological screening of stroke: A classical multi-exams approach including Duplex Ultrasound examination of neck vessels (DUS), trans esophageal echocardiography (TEE) and Magnetic Resonance Angiography of neck and brain vessels (MRA) and a novel single exam MSCT strategy, covering heart, neck and brain vessels. Identification of major etiology of stroke, including cardiac sources of embolism and atheroma of the aortic arch, carotid and vertebral arteries and intra-cranial vessels was performed using the two strategies.

 

Results

47 patients were recruited between 06/2006 and 10/2007. TOAST classification was correctly determined by CT in 42/47 cases. Multi-detector raw CT exploration exhibited similar results compared with classical methods regarding atheromatous causes of stroke (carotid stenosis 11/12 cases, aortic atheroma 3/4 cases). One intra-cardiac thrombus and one tumors were detected at this stage by MSCT alone. Detection of minor cardiac sources by MSCT such as FOP was possible when large but remained difficult if small, while the clinical meaning of these abnormalities is still debated.

 

Conclusions

MSCT is a promising tool in the etiological screening of ischemic stroke.



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Abstract
abdomen, aorta, Body, brain, Cardiac, carotids, coronary angiography, Head, head CTA, MDCT Users Meeting, Neck, neck CTA, Neuro, prospective, retrospective, stroke, Vascular
 

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