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Multidetector CT Can Identify The Cause Of Ischemic Strokes, Study.

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According to a study published online and in the January issue of Radiology,  multidetector computed tomography (CT) helps identify the causes of ischemic strokes, the most common type of stroke, which could help life-saving by speeding delivery of treatments. "Our results suggest that multidetector CT could become the first-line imaging tool for identifying the cause of acute ischemic stroke," said the lead author of the study, Loic Boussel, M.D., Ph.D., professor of radiology at Louis Pradel Hospital in Bron, France. An ischemic stroke occurs when occlusion in an artery, often from a blood clot or a fatty deposit due to atherosclerosis, interrupts blood flow to an area of the brain. This type of stroke can originate in the heart, in the form of a blood clot that travels to the head, or from blood vessels in the neck (extracranial carotid arteries) and head (intracranial arteries). Ischemic stroke represents nearly 87 % of stroke cases, according to the American Stroke Association.

Multidetector CT offers rapid diagnosis.

Early diagnosis of the cause of ischemic stroke is important for secondary stroke prevention. Anticoagulant therapy to prevent clot formation is the best treatment for most of the cardiac sources of stroke, while surgery is needed for strokes caused by severe narrowing of the extracranial carotid artery. Physicians use a combined imaging protocol to recognize the cause of an ischemic stroke. The protocol typically consists of duplex ultrasonography, MR angiography or CT angiography of the neck and brain vessels, and transthoracic and transesophageal echocardiography. Dr. Boussel explained disadvantages of this protocol : "This approach is time-consuming and expensive, and could delay secondary stroke prevention strategies."

In the new study, Dr. Boussel and colleagues analyzed the multidetector CT as a faster and more cost-effective way to detect the main causes of ischemic stroke. The researchers compared a single-session multidetector CT examination of the heart, neck and brain vessels with standeard imaging methods in 46 patients who had recently suffered from ischemic stroke. Approximately half of the stroke patients had cardiac sources, while in 20 % of cases,  arterial atherosclerosis was the main leading factor. Multidetector CT was able to detect cardiac sources of stroke in 18 of 25 cases, with a sensitivity of 72 %. The technique's sensitivity increased up to 100 % for detection of major arterial atherosclerosis. Generally, multidetector CT enables stroke classification in 38 of the 46 patients, or 83 %. Dr. Boussel said: "CT allows a fast diagnosis and helps identify the cause of the stroke during a single examination. Moreover, because it is quick, the exam is well tolerated, which is critical in acute stroke patients who may be unstable and agitated." Dr. Boussel noted that the CT protocol has two main disadvantages: it exposes the patient to a significant radiation dose and requires two intravenous contrast material injections to study the chest and neck areas. Dr. Boussel said that advances in CT equipment technology could help reduce the radiation dose and the total amount of iodinated contrast material required. More studies are needed to validate the results and to analyze the technique's cost-effectiveness.


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