Title:Magnetic Resonance Perfusion Imaging Provides a Significant Tool for the Identification of Cardioembolic Stroke
Volume: 13
Issue: 4
Author(s): Chun-Hsien Lin, Yuan-Hsiung Tsai, Jiann-Der Lee, Hsu-Huei Weng, Jen-Tsung Yang, Leng-Chieh Lin, Ya-Hui Lin, Chih-Ying Wu, Ying-Chih Huang, Huan-Lin Hsu, Meng Lee, Chia-Yu Hsu, Yi-Ting Pan and Yen-Chu Huang
Affiliation:
Keywords:
Cardioembolism, stroke, MRI, perfusion, LAA.
Abstract: Despite advances in imaging techniques and detailed examinations to determine the etiology
of a stroke, the cause still remains undetermined in about one fourth of all ischemic strokes. The
aim of this prospective study was to determine whether perfusion magnetic resonance imaging
(MRI) can differentiate cardioembolic stroke from large artery atherosclerosis (LAA). We recruited
17 cardioembolic stroke and 22 LAA stroke patients, who were classified according to the Trial of
Org 10172 in Acute Stroke Treatment and underwent perfusion MRI within 24 hours after the onset
of stroke. The patients with cardioembolic stroke had more severe initial stroke severity and larger
volumes of initial and final infarct compared to those with LAA stroke. Receiver operating characteristic
curve analysis showed that the ratio of time to maximum of the residual curve (Tmax) volume
for a 2-, 3-, 4- or 5-s lag over Tmax volume for a 8s lag all had excellent area under the curve values
(> 0.9) to predict cardioembolic stroke. After adjusting for initial National Institute of Health Stroke
Scale scores, a threshold of 3.73 for (Tmax > 4s volume)/(Tmax > 8s volume) had the highest odds ratio
to predict cardioembolic stroke (p=0.012; odds ratio: 58.5; 95% confident interval: 2.5-1391.1), with
87.5% sensitivity and 94.4% specificity. In conclusion, perfusion MRI could be a reliable tool to
identify cardioembolic stroke with its lower collateral. This is important as it could be used to reveal
the exact mechanism and provide supportive evidence to classify a stroke.