Abstract
PurposeTo validate the feasibility of free-breathing, non-gated, high-pitch heart-to-brain computed tomography arteriography (CTA) in acute ischemic stroke and the capability of non-gated heart-to-brain CTA in showing cardiac anatomy.Materials and MethodsThe study protocol was approved by the institutional medical ethics review board. Free-breathing, non-gated, high-pitch heart-to-brain CTA was performed on patients with acute ischemic stroke referred for multimodal CT using a third-generation dual-source CT. Patients scheduled for ECG-triggered heart-to-brain CTA served as controls. Quantitative and/or qualitative image quality of the four cardiac chambers, left atrial appendage, interventricular and interatrial septa, carotid arteries, and coronary arteries were evaluated and compared between the two groups.ResultsFree-breathing, non-gated, high-pitch heart-to-brain CTA was performed on 30 patients with acute ischemic stroke, whereas the control group included 31 cases. There is no significant difference in the image quality of CTAs between the two groups at cardiac chambers and carotid arteries. The image quality of coronary arteries also showed no significant difference between the two groups. The mean dose length products of CTA in the two groups were 129.1 ± 30.5 mGy cm and 121.6 ± 30.3 mGy cm, respectively. Cardiac abnormality can be shown in patients with acute ischemic stroke.ConclusionIt is feasible to use free-breathing, non-gated, high-pitch heart-to-brain CTA with dual-source CT in acute ischemic stroke for cardiac etiology screening.
Highlights
Ischemic stroke has various etiologies, including large-artery atherosclerosis, cardiogenic emboli, small-vessel occlusion, and other determined or undetermined etiology [1]
Patients with acute ischemic stroke who were referred for multimodal CT from March 2018 to December 2018 were recruited consecutively, and informed consent was obtained from each patient or his/her representative
There was no significant difference in the quantitative image quality between the two groups in bilateral internal carotid artery (ICA), bilateral common carotid artery (CCA), bilateral vertebral arteries, ascending aorta, and descending aorta
Summary
Ischemic stroke has various etiologies, including large-artery atherosclerosis, cardiogenic emboli, small-vessel occlusion, and other determined or undetermined etiology [1]. Because of increased concern about atherosclerosis and hyperlipidemia, the primary prevention of ischemic stroke has been improved through recent years. The overall incidence rate of ischemic stroke decreased, the incidence of cardiogenic stroke has increased [2]. Patients with cardiogenic stroke showed more severe presentations and worse prognoses [3]. Non-Gated Heart to Brain CTA the identification of cardiogenic stroke should be emphasized in the management of patients with acute ischemic stroke, especially for the possible etiology of cardiogenic stroke. As a semi-invasive procedure, TEE needs adequate preparation, which makes it inappropriate for patients with acute ischemic stroke when emergent management may be needed [6]
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