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Cerebrovascular Dissemination in Time and Space as a Predictor of Cardioembolism
João André Sousa1, Mafalda Mendes-Pinto2, João Sargento-Freitas3
1Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
Insights
Dissemination in time and space (DTS) is a specific marker for identifying cardioembolic stroke. This imaging characteristic can aid in determining the cause of ischemic stroke.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Cardioembolism frequently recurs, causing lesions in multiple cerebrovascular areas.
- Dissemination in time and space (DTS) is an imaging concept used in other neurological conditions but not yet for ischemic stroke etiology.
- Assessing DTS may help diagnose cardioembolic stroke.
Purpose of the Study:
- To evaluate the diagnostic utility of DTS in identifying cardioembolic stroke.
- To determine if DTS can serve as a marker for cardioembolic etiology in ischemic stroke patients.
Main Methods:
- Retrospective cohort study of 661 acute ischemic stroke patients.
- Exclusion of patients with coexisting etiologies, incomplete data, or no acute vascular lesions on CT.
- Analysis of lesion location, previous lesions, and areas to determine DTS, focusing on anterior and posterior cerebrovascular territories.
Main Results:
- Cardioembolism showed the highest DTS prevalence (30.47%).
- Dissemination in time (DT) was more common in atherosclerotic stroke (9.88%), while dissemination in space (DS) was more prevalent in arterial dissection (3.33%).
- DTS demonstrated 81.67% specificity and 30.47% sensitivity for cardioembolism, with a significant association between DTS and stroke etiology (P < .001).
Conclusions:
- DTS is a specific predictor for cardioembolic stroke.
- The DTS imaging pattern can assist in guiding the etiological investigation of ischemic stroke.
- Further research may refine the role of DTS in stroke diagnosis.
Background:
Cardioembolism has tendency to recur and cause lesions in distinct cerebrovascular territories. Using the imaging characteristics of cerebral lesions to determine dissemination in time and space (DTS) is a concept already used in other neurologic conditions; however, it has never been applied as a diagnostic tool in ischemic stroke etiology.
Aim:
This study aimed to assess DTS as a diagnostic marker of cardioembolism.
Methods:
We enrolled consecutive patients with acute ischemic stroke of various etiologies admitted in a cerebrovascular disease nursery from a university hospital in a retrospective cohort study. We excluded patients with coexisting etiologies, incomplete study, or without an acute vascular lesion on computed tomography scan. Lacunar infarctions were not considered. Cerebrovascular territory was divided into right anterior, left anterior, and posterior. Localization of the acute vascular lesion(s), existence of previous vascular lesions, and their respective areas were analyzed. The presence of dissemination in time, space, or DTS was determined.
Results:
We included 661 patients (mean age: 74.05 years (SD: 13.01)). Cardioembolism was the etiology with most DTS (30.47% of cardioembolic strokes); DT occurred more frequently within the atherosclerotic subtype (9.88%); DS was more prevalent within the arterial dissection group (3.33%). There was a statistically significant difference in stroke etiology between patients with DTS and patients without dissemination (P < .001). DTS had 81.67% specificity, 30.47% sensitivity, 66.67% positive predictive value, and 49.40% negative predictive value for the identification of cardioembolism.
Conclusion:
DTS is a specific diagnostic predictor of cardioembolic stroke and may be helpful in guiding etiologic investigation.