Study: MRI and Echocardiography Together Can ID More Causes of Stroke Before They Strike

Based on a new study released today, researchers urge more comprehensive imaging for patients presenting to hospitals with stroke symptoms. Using both MRI and echocardiography to image the heart greatly enhances the detection of thecause and selection of the best treatment of cardioembolic strokes, the"meanest" type of stroke.

A cardioembolic stroke occurs when a thrombus (clot) dislodges from the heart, travels through the cardiovascular system and lodges in the brain, first cutting off the blood supply and then often causing a hemorrhagic bleed -- a double whammy of both types of stroke, ischemic first and then hemorrhagic. The study found that MRI detected nearly twice as many sources of stroke in the heart than echocardiogram alone. It also showed theability of MRI to reveal more heart disease conditions that contribute to clot formation in the first place. Echocardiography, however, was strong inthe detection of heart valve lesions. Combined, these imaging systems can more clearly identify underlying causes of future stroke, helping doctors decide the best initial therapy and the best treatment to prevent asecondary stroke.

The research was presented today at the Society of Interventional Radiology's 32nd Annual Scientific Meeting.

"This can revolutionize patient care because we can detect the underlying cause of the stroke and prevent it from occurring again," says lead author John Sheehan, M.D., an interventional radiologist at Northwestern University and Northwestern Memorial Hospital. "A potential cardiac source should be considered in all patients presenting with ischemic strokes. All stroke patients should routinely have an MRI and ultrasound of their heart, in addition to having their brain and carotids imaged with CT and MRI. It's nice to be on the front end of a stroke --able to stop it, than on the back end, figuring out how to deal with its damage."

Stroke teams generally consist of emergency room physicians, neurologists and interventional radiologists. Interventional radiologistsare a critical part of the stroke team because they can diagnose and treatischemic stroke with clot-busting drugs, or open a blocked carotid artery nonsurgically. They are also actively involved in creating more stroke teams across the country.

Cardioembolic strokes, which account for 20 percent of embolic strokes,have a worse prognosis, producing larger, more disabling strokes that aremore likely to recur compared to other types of stroke. Blood clots can betreated with drugs before they can leave the heart, in conjunction with treating identified heart conditions, to prevent another life-threatening stroke. In the United States stroke is the leading cause of adult disability and the third leading cause of death; only heart disease and cancer cause more deaths annually.

In the study, of the 93 patients who had an MRI and echocardiogram oftheir heart after a stroke, MRI detected nearly twice as many potential causes of stroke originating from the heart compared to echocardiography. MRI also detected significant heart conditions that predispose a patient tostroke in 30 percent of patients compared to echocardiography. These additional findings included acute myocardial infarction, myocardial scarring and left ventricular aneurysms. Echocardiography was, however,more sensitive to detecting potential embolic lesions on prosthetic cardiacvalves and strokes related to a hole in the heart.

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