Dc. Park et al., MRI features of infarcts with potential cardiac source of embolism in the Yonsei Stroke Registry (YSR), Korea, YONSEI MED, 41(4), 2000, pp. 431-435
The determination of the embolic source is crucial to understanding the pat
hogenesis of ischemic stroke, the initiation of appropriate therapy, and th
e prevention of recurrent infarctions. In this study we undertook to identi
fy the characteristic features on magnetic resonance images of patients who
had suffered from stroke due co cardiac embolism (CE), as classified by TO
AST (possible and probable). We retrospectively studied magnetic resonance
imaging (MRI) findings of patients with ischemic stroke from the Yonsei Str
oke Registry (YSR). On the basis of the TOAST classification, 92 patients w
ere identified to have a potential cardiac source of embolism (PCSE), in wh
ich 69 patients were found to have high-risk PCSE and 23 patients medium-ri
sk PCSE. To compare their imaging characteristics, another group of 49 pati
ents who were found to have had a stroke due to large artery-to-artery (ATA
) embolism-common or internal carotid artery (CCA, ICA)-were identified. In
volvement of the simultaneous superficial and deep territories (58.7%; 6.1%
, p<0.001), and combined new anterior and old posterior circulation (15.2%;
2.0%, p=0.016) were more frequent in PCSE than ATA embolism. Bilateral ant
erior hemispheric involvement was also more frequent in the PCSE group, but
it did nor reach statistical significance (13.0%; 4.1%, p=0.090). ATA embo
lism tended to involve only superficial territories compared to PCSE (71.4%
; 28.3%, p<0.001). There were no topographic differences between the high-r
isk and medium-risk groups. With respect to the etiology of PCSE in our pop
ulation, atrial fibrillation was the most common. Characteristic MRI featur
es of patients with PCSE, which were not documented previously by computed
tomography (CT) included: old and new, involvement of multiple different va
scular territories, bilateral anterior hemisphere, as well as anterior and
posterior circulation. These MRI features, together with simultaneous super
ficial and deep territorial involvement, help to differentiate the underlyi
ng embolic sources, whether they are cardiac or ATA in origin.