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Updated: Mar 6, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Total Bolus Transit Time Predicts Cardiac Dysfunction in Acute Ischemic Stroke and Transient Ischemic Attack
Simone Bellavia1,2, Pier Andrea Rizzo1,2, Irene Scala1,2
1Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
Bolus tracking during brain CTA can quickly identify reduced ejection fraction (EF) and cardioembolic stroke. This technique aids in faster diagnosis and appropriate patient selection for further tests in emergency settings.
Area of Science:
- Radiology
- Cardiology
- Neurology
Background:
- Rapid diagnosis of cardioembolic stroke/TIA is challenging due to insufficient data from current cardiac assessments.
- Brain CT angiography (CTA) is routinely used in acute stroke evaluation.
- Bolus tracking is a readily available technique during CTA.
Purpose of the Study:
- To evaluate the utility of bolus tracking during brain CTA for identifying reduced ejection fraction (EF) and cardioembolic etiology in acute stroke patients.
- To determine if bolus tracking parameters correlate with EF and can predict cardioembolic stroke.
Main Methods:
- Retrospective analysis of CTA and echocardiography data from 443 acute ischemic stroke/TIA patients.
- Measurement of total transit time (TTT) parameters (T40HU, T100HU, ΔT100-T40HU) from CTA.
- Ejection fraction (EF) measurement using transthoracic echocardiography (Simpson biplane method).
Main Results:
- A significant inverse correlation was found between EF and T40HU, T100HU, and ΔT100-T40HU.
- ΔT100-T40HU showed good discriminatory ability for heart failure (AUROC=0.88).
- Multivariate analysis confirmed T40HU, T100HU, and ΔT100-T40HU as independent predictors of heart failure and cardioembolic stroke.
Conclusions:
- Bolus tracking during CTA is a reliable radiological tool for identifying heart failure and cardioembolic stroke.
- This technique facilitates faster diagnostic workup in acute stroke patients.
- It enables appropriate selection of further diagnostic investigations in emergency settings.
Background:
Diagnosing cardioembolic stroke/transient ischemic attack (TIA) rapidly remains a major challenge. Current emergency cardiac assessments often provide insufficient data. This study tests whether bolus tracking, a readily available technique during brain CTA, can be leveraged to quickly identify reduced ejection fraction (EF) and potential cardioembolic etiology in acute stroke patients.
Patients And Methods:
We retrospectively analyzed CTA and echocardiography data from acute ischemic stroke/TIA patients across two comprehensive stroke centers. We measured total transit time (TTT) based on aortic attenuation values of 40 Hounsfield Units (T40HU) and 100 HU (T100HU) obtained during routine CTA. ΔT100-T40HU, representing the time difference required for aortic contrast enhancement to increase from 40 to 100 HU, was also calculated as a key parameter. EF was measured by transthoracic echocardiography using the Simpson biplane method.
Results:
In a cohort of 443 patients, we found a statistically significant inverse correlation between EF and T40HU, T100HU, and ΔT100-T40HU. Notably, ΔT100-T40HU demonstrated good discriminatory ability for identifying heart failure (AUROC = 0.88) and poor discriminatory ability for cardioembolic stroke (AUROC = 0.66). Multivariate analysis further confirmed that T40HU, T100HU, and ΔT100-T40HU were independent predictors of both heart failure and cardioembolic stroke based on the TOAST classification criteria.
Conclusion:
Bolus tracking during CTA provides a reliable and easily accessible radiological tool for the identification of heart failure and cardioembolic stroke, enabling a faster diagnostic workup and facilitating appropriate selection of further diagnostic investigations within the acute emergency setting.
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