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Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients

BACKGROUND: Aortic Atheroma (AoA) is an independent risk factor for new and recurrent stroke. AoA ulceration and mobility are associated with an increased risk for brain embolism. Transesophageal echocardiography (TEE) is the gold standard for detection and measurement of AoA in stroke/TIA patients....

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Autores principales: Faber, Theodore, Rippy, Ashley, Hyslop, W Brian, Hinderliter, Alan, Sen, Souvik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025943/
https://www.ncbi.nlm.nih.gov/pubmed/24851233
http://dx.doi.org/10.4172/2329-6895.1000139
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author Faber, Theodore
Rippy, Ashley
Hyslop, W Brian
Hinderliter, Alan
Sen, Souvik
author_facet Faber, Theodore
Rippy, Ashley
Hyslop, W Brian
Hinderliter, Alan
Sen, Souvik
author_sort Faber, Theodore
collection PubMed
description BACKGROUND: Aortic Atheroma (AoA) is an independent risk factor for new and recurrent stroke. AoA ulceration and mobility are associated with an increased risk for brain embolism. Transesophageal echocardiography (TEE) is the gold standard for detection and measurement of AoA in stroke/TIA patients. Cardiovascular MRI (cMRI) could be an alternative, non-invasive imaging modality for stroke/TIA patients. The objective of this study was to assess the accuracy and correlation of AoA detected and measured by cMRI versus TEE in patients with recent stroke/TIA. METHODS AND RESULTS: Twenty-two stroke/TIA patients undergoing TEE as a part of their stroke workup consented to a protocol-mandated cMRI performed on a 1.5 T magnet. The protocol included an axial non-breathhold EKG-gated dual-echo spin echo MRI of the thoracic aorta (TR/TE1/TE2=900/29/69) and a contrast-enhanced breathhold 3D gradient-echo image of the thorax (flip/TR/TE=12/4.0/1.71). Maximum plaque thickness, ulceration (≥ 2 mm) and mobility of AoA were assessed in the proximal (ascending and proximal arch) and distal (distal arch and descending) segments of thoracic aorta by a cardiologist to interpret the TEE and a radiologist to interpret the cMRI. There was good correlation between cMRI and TEE in measurement of plaque thickness in the proximal segments (R=0.73, p<0.0001) and the distal segments (R=0.81, p<0.0001) of the aortic arch (AA). cMRI had a high degree of accuracy in detecting measurable AoA (≥ 1 mm) in the proximal segments (sensitivity 90%, specificity 100%), as well as the distal segments (sensitivity 67%, specificity 100%). cMRI also had a high degree of accuracy in detecting significant AoA (≥ 4 mm) in proximal segments (sensitivity 71%, specificity 93%), as well as distal segments (sensitivity 71%, specificity 100%). CONCLUSION: The study showed a high degree of accuracy and correlation of AoA detected and measured by cMRI as compared to TEE in patients with recent stroke/TIA. This technique has limitations in detection of AoA ulceration, and protocols assessing AoA mobility need to be developed.
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spelling pubmed-40259432014-05-19 Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients Faber, Theodore Rippy, Ashley Hyslop, W Brian Hinderliter, Alan Sen, Souvik J Neurol Disord Article BACKGROUND: Aortic Atheroma (AoA) is an independent risk factor for new and recurrent stroke. AoA ulceration and mobility are associated with an increased risk for brain embolism. Transesophageal echocardiography (TEE) is the gold standard for detection and measurement of AoA in stroke/TIA patients. Cardiovascular MRI (cMRI) could be an alternative, non-invasive imaging modality for stroke/TIA patients. The objective of this study was to assess the accuracy and correlation of AoA detected and measured by cMRI versus TEE in patients with recent stroke/TIA. METHODS AND RESULTS: Twenty-two stroke/TIA patients undergoing TEE as a part of their stroke workup consented to a protocol-mandated cMRI performed on a 1.5 T magnet. The protocol included an axial non-breathhold EKG-gated dual-echo spin echo MRI of the thoracic aorta (TR/TE1/TE2=900/29/69) and a contrast-enhanced breathhold 3D gradient-echo image of the thorax (flip/TR/TE=12/4.0/1.71). Maximum plaque thickness, ulceration (≥ 2 mm) and mobility of AoA were assessed in the proximal (ascending and proximal arch) and distal (distal arch and descending) segments of thoracic aorta by a cardiologist to interpret the TEE and a radiologist to interpret the cMRI. There was good correlation between cMRI and TEE in measurement of plaque thickness in the proximal segments (R=0.73, p<0.0001) and the distal segments (R=0.81, p<0.0001) of the aortic arch (AA). cMRI had a high degree of accuracy in detecting measurable AoA (≥ 1 mm) in the proximal segments (sensitivity 90%, specificity 100%), as well as the distal segments (sensitivity 67%, specificity 100%). cMRI also had a high degree of accuracy in detecting significant AoA (≥ 4 mm) in proximal segments (sensitivity 71%, specificity 93%), as well as distal segments (sensitivity 71%, specificity 100%). CONCLUSION: The study showed a high degree of accuracy and correlation of AoA detected and measured by cMRI as compared to TEE in patients with recent stroke/TIA. This technique has limitations in detection of AoA ulceration, and protocols assessing AoA mobility need to be developed. 2013-11-01 /pmc/articles/PMC4025943/ /pubmed/24851233 http://dx.doi.org/10.4172/2329-6895.1000139 Text en Copyright: © 2013 Faber T, et al. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Article
Faber, Theodore
Rippy, Ashley
Hyslop, W Brian
Hinderliter, Alan
Sen, Souvik
Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
title Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
title_full Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
title_fullStr Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
title_full_unstemmed Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
title_short Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
title_sort cardiovascular mri in detection and measurement of aortic atheroma in stroke/tia patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025943/
https://www.ncbi.nlm.nih.gov/pubmed/24851233
http://dx.doi.org/10.4172/2329-6895.1000139
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