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Updated: Jul 10, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Reliability of aortic MRI at 3 Tesla in patients with acute cryptogenic stroke
A Harloff1, P Dudler, A Frydrychowicz
1Department of Neurology and Clinical Neurophysiology, University of Freiburg, Breisacher Str 64, D-79106 Freiburg, Germany. andreas.harloff@uniklinik-freiburg.de
Objectives:
To evaluate a new three dimensional (3D) MRI protocol for the reliable detection of aortic high risk plaques compared with transoesophageal echocardiography (TOE) and to test the reliability of additional MRI in stroke of undetermined aetiology.
Methods:
74 acute stroke patients were examined by both TOE and MRI at 3 Tesla with special regard to aortic high risk plaques (ie, > OR = 4 mm, superimposed thrombi). ECG synchronised pre- and post-contrast T1 weighted 3D imaging (spatial resolution approximately 1 mm3) covering the thoracic aorta was employed. In plaques > OR = 3 mm, additional two dimensional T2 imaging and time resolved (CINE) imaging sequences were performed. Aetiology of brain ischaemia was classified according to modified TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Aortic high risk embolic sources detected by MRI in patients with cryptogenic stroke were evaluated.
Results:
Differences in maximum aortic wall thickness for TOE and MRI were not statistically significant for all aortic segments. The overall number of high risk plaques detected by MRI (n = 74) was substantially higher compared with TOE (n = 47). Most noticeably, MRI identified aortic high risk pathologies in 8/26 (30.8%) patients with cryptogenic stroke after standard diagnostics, including TOE (n = 2: dissection or thrombus; n = 6: plaques > OR = 4 mm).
Conclusions:
Our results demonstrate the feasibility of this 3D MRI protocol for the reliable detection of aortic high risk plaques in acute stroke patients. Because of improved visualisation of the aortic arch and the detection of additional embolic sources not seen by standard diagnostics, this novel technique may become a valuable tool for future patients with cryptogenic stroke.
Insights
A new 3D MRI protocol reliably detects aortic high-risk plaques in stroke patients, identifying more sources of embolism than standard methods. This advanced imaging may improve diagnosis for cryptogenic stroke cases.
Area of Science:
- Cardiovascular Imaging
- Neurology
- Radiology
Background:
- Aortic high-risk plaques are a significant source of embolism in stroke.
- Current diagnostic methods may not fully detect these plaques.
Purpose of the Study:
- To evaluate a novel 3D MRI protocol for detecting aortic high-risk plaques.
- To compare MRI's efficacy against transoesophageal echocardiography (TOE).
- To assess MRI's utility in identifying stroke causes in undetermined aetiology cases.
Main Methods:
- 74 acute stroke patients underwent both TOE and 3 Tesla 3D MRI.
- ECG-synchronized pre- and post-contrast T1-weighted 3D imaging covered the thoracic aorta.
- Additional 2D T2 and CINE imaging were used for plaques ≥3 mm.
Main Results:
- MRI detected a substantially higher number of high-risk plaques (n=74) compared to TOE (n=47).
- MRI identified aortic high-risk pathologies in 30.8% of cryptogenic stroke patients.
- This included plaques ≥4 mm, dissection, or thrombus missed by standard diagnostics.
Conclusions:
- The 3D MRI protocol is feasible for reliable detection of aortic high-risk plaques in acute stroke patients.
- Improved visualization of the aortic arch enhances diagnostic capability.
- This novel MRI technique shows promise for diagnosing cryptogenic stroke by detecting additional embolic sources.
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