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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Features of brain magnetic resonance imaging diffusion-weighted images of aortogenic embolic stroke
Jun-Ichiro Shimada1, Masahiro Yasaka, Yoshiyuki Wakugawa
1Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center.
Insights
Acute aortogenic embolic stroke often presents with multiple, small brain lesions and affects the vertebrobasilar system, distinguishing it from cardioembolic stroke.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Features of acute aortogenic embolic stroke on diffusion-weighted imaging (DWI) require further clarification.
- Comparison between aortogenic and cardioembolic stroke is essential for understanding stroke etiology.
Purpose of the Study:
- To elucidate the distinct features of acute aortogenic embolic stroke on DWI.
- To compare imaging findings between patients with aortogenic and cardioembolic stroke.
Main Methods:
- Retrospective analysis of 40 patients with acute aortogenic embolic stroke and 40 matched controls with acute cardioembolic stroke.
- Diagnosis of aortogenic stroke based on specific clinical, echocardiographic, and neuroimaging criteria.
- Comparison of infarct lesion characteristics (number, site, diameter) on DWI between groups.
Main Results:
- Aortogenic stroke patients more frequently had multiple lesions (≥3) compared to cardiogenic patients (25.0% vs. 2.5%).
- Lesions in aortogenic stroke were smaller (maximal diameter <30mm) more often than in cardiogenic stroke (77.5% vs. 20.0%).
- Vertebrobasilar system involvement was significantly higher in aortogenic stroke (55.0% vs. 10.0%).
Conclusions:
- Acute aortogenic embolic stroke is characterized by multiple, small infarct lesions.
- The vertebrobasilar system is a common site for lesions in acute aortogenic embolic stroke.
- These findings help differentiate aortogenic from cardioembolic stroke.
Background:
The features of acute aortogenic embolic stroke on magnetic resonance diffusion-weighted imaging (DWI) have not been fully elucidated, so we compared patients with acute aortogenic embolic stroke and those with acute cardioembolic stroke.
Methods And Results:
This study included 40 consecutive patients with acute aortogenic embolic stroke, and 40 age- and sex-matched patients with acute cardioembolic stroke. The diagnosis of aortogenic embolic stroke was made when patients met 5 criteria: (1)acute neurologic event lasting >24h; (2) positive signals on DWI; (3) atherosclerotic lesions ≥3.5-mm thick at the aortic arch on transesophageal echocardiography; (4) neuroradiologic features suggesting embolic stroke, such as lesions involving the brain cortex or the re-opening phenomenon of previously occluded vessels on Magnetic Resonance Angiography (MRA); and (5) absence of other embolic sources, including heart disease and carotid stenosis. The number, site, and maximal diameter of the infarct lesions on DWI were compared between the aortogenic and cardiogenic groups. The aortogenic patients more frequently had ≥3 lesions (25.0% vs. 2.5%, P<0.01), lesions with a maximal diameter <30mm (77.5% vs. 20.0%, P< 0.001), and vertebrobasilar system lesions (55.0% vs. 10.0%, P< 0.001) than the cardiogenic patients.
Conclusions:
Acute aortogenic embolic stroke is characterized by multiple (≥3) and small lesions, and involvement of the vertebrobasilar system.
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