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Identification of intracardiac thrombi in stroke patients with indium-111 platelet scintigraphy
Insights
Platelet scintigraphy (PSC) effectively detects intracardiac thrombi in stroke patients. This imaging method aids in diagnosing cardiac embolism causes, improving patient management.
Area of Science:
- Nuclear Medicine
- Cardiology
- Neurology
Background:
- Platelet scintigraphy (PSC) using indium-111 labelled platelets is established for detecting intracardiac thrombi in heart disease.
- Suspected cardiac embolism is a significant concern in stroke patients, necessitating accurate diagnostic tools.
Purpose of the Study:
- To evaluate the utility of platelet scintigraphy (PSC) in identifying intracardiac thrombi in stroke patients with suspected cardiac embolism.
- To assess the diagnostic value of PSC for cardiac sources of embolism compared to carotid artery imaging.
Main Methods:
- Performed PSC of the heart and neck vessels in 27 stroke patients with suspected cardiac embolism.
- Conducted control PSC on 10 patients with carotid artery atherosclerosis but no heart disease.
- Utilized two-dimensional echocardiography and open-heart surgery for verification in select cases.
Main Results:
- Cardiac PSC showed pathological findings in 13 of 27 stroke patients, visualizing platelet accumulations in the atria, left ventricle, and aortic valve.
- Carotid PSC was positive in 6/10 patients with carotid disease and only 2/27 stroke patients, indicating cardiac origin was more frequent.
- Echocardiography confirmed findings in 8/13 patients with positive heart PSC, including intraventricular thrombi and valvular disease; surgery confirmed thrombi in 2 patients.
Conclusions:
- Platelet scintigraphy (PSC) is a valuable tool for detecting intracardiac thrombi in stroke patients with suspected cardiac embolism.
- PSC findings correlate with echocardiographic and surgical results, supporting its role in diagnosing cardiac sources of stroke.
Abstract:
Platelet scintigraphy (PSC) with indium-111 labelled platelets has been confirmed as an adequate method for the detection of intracardiac thrombi in patients with heart disease. We performed PSC of the heart and the neck vessels in 27 stroke patients with suspected cardiac embolism and as control on 10 patients with atherosclerotic lesions of the carotid arteries without evidence of heart disease. The carotid PSC was positive in 6 of 10 patients with carotid disease, and twice in the 27 with suspected cardiac embolism. In these 27 the PSC of the heart indicated pathological conditions 13 times. Pathological platelet accumulations could be visualized in 3 cases in the atrial space, in 9 cases in the region of the left ventricle, and once at the aortic valve. Scintigraphy was negative in all 10 patients with atherosclerosis of the neck vessels. The two-dimensional echocardiography revealed pathological findings in 8 of the 13 patients with positive heart PSC (3 with intraventricular thrombi, 3 with valvular disease, 2 with decreased ventricular contractility) and was normal in the 10 control patients. Open-heart surgery was performed in 2 patients with pathological PSC and revealed an intracardiac thrombus. Three of 4 patients with positive atrial PSC showed mitral or aortic valve disease. These results suggest that PSC can provide a valuable method for detecting cardiac thrombi in stroke patients.