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| |  Combination Imaging With MRI and Ultrasound May Prevent Strokes: Presented at SIR By Ed Susman SEATTLE, WA -- March 8, 2007 -- Combination of 2 imaging modalities -- magnetic resonance imaging (MRI) and echocardiography -- may help doctors find the sources of strokes and then find ways of preventing the strokes from occurring, according to research presented here at the 32nd annual meeting of the Society of Interventional Radiology (SIR). Study presenter John Sheehan, MD, interventional radiologist, Northwestern Memorial Hospital and Northwestern University School of Medicine, Chicago, Illinois, United States, said that the use of MRI is able to find more sources of stroke in the heart -- particularly emboli -- than echocardiography. However, he said that echocardiography is able to identify vegetative lesions on heart valves with greater accuracy than MRI. "This can revolutionise patient care because we can detect the underlying cause of the stroke and prevent it from occurring again," Dr. Sheehan said in his oral presentation March 5th. "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 carotid arteries imaged with computer-assisted tomography 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." In the study of 93 patients who had an MRI and echocardiogram of their heart after a stroke, MRI detected nearly twice as many potential causes of stroke originating in the heart compared with echocardiography. MRI also detected significant heart conditions that predispose patients to stroke in 30% of patients compared with echocardiography, Dr. Sheehan said. Through use of heart MRI, the researchers found 9 clots (9.7%) compared with 4 clots (4.3%) located by echocardiography. Echocardiography found 3 vegatative masses on heart valves, but MRI did not identify any of those lesions. The MRI also identified acute myocardial infarction, myocardial scarring, and left ventricular aneurysms. Echocardiography was more sensitive to detecting potential embolic lesions on prosthetic cardiac valves and strokes related to a hole in the heart. Dr. Sheehan and his colleagues calculated that, used in the overall population, the combination of modalities could double the chances of finding a stroke cause before it happens. "By using cardiac MRI and echocardiography to assess stroke patients, we have 2 sets of eyes -- 2 ways to see what is causing the stroke to provide the best immediate care, and 2 ways to see what problems lie ahead for this patient that we could prevent with better long-term care," Dr. Sheehan added. "The earlier we can detect underlying cardiac problems, the more quickly we can intervene to prevent future strokes. One stroke is more than enough," he said. "The chances of experiencing another stroke can be dramatically reduced by taking appropriate actions."
[Presentation title: Evaluation of Patients With Suspected Cardioembolic Stroke With Cardiovascular MR: Comparison With Echocardiography. Abstract 132]
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