Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients
|Theodore Faber1, Ashley Rippy1, W Brian Hyslop2, Alan Hinderliter2 and Souvik Sen1*|
|1University of South Carolina School of Medicine, Department of Neurology, Columbia, South Carolina, USA|
|2University of North Carolina School of Medicine, Department of Radiology and Cardiology, Chapel Hill, North Carolina, USA|
|Corresponding Author :||Souvik Sen
Professor and Chair, Department of Neurology
University of South Carolina School of Medicine
8 Medical Park, Suite 420 Columbia, South Carolina 29203, USA
E-mail: [email protected]
|Received October 04, 2013; Accepted October 30, 2013; Published November 06, 2013|
|Citation: Faber T, Rippy A, W Brian Hyslop, Hinderliter A, Sen S (2013) Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients. J Neurol Disord 1:139. doi: 10.4172/2329-6895.1000139|
|Copyright: © 2013 Faber T, et al. 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.|
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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 EKGgated 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.