Strokes are currently the number two cause of death in Austria and the most frequent cause of serious impairments among adults. Besides risk factors such as dyslipidemia, hypertension, lack of exercise and obesity, there are clear-cut physiological changes that promote the occurrence of strokes. A new study by Professor Dr. Luca Saba from the University of Cagliari (Sardinia), now being presented at the European Congress of Radiology (ECR 2007) at Austria Center Vienna, shows that the risk of stroke increases almost ten-fold if the carotid artery wall equals or exceeds a thickness of one millimetre.

A person who knows about this can take appropriate preventive measures. This knowledge is determined in a matter of minutes by means of multi-detector computer tomography (MDCT), which is why this method has increasingly become an ultra-effective early warning system for diseases like strokes or coronaries. "MDCTs show the entire cardio-vascular system, from the heart to the smallest blood vessels in the brain," explained Professor Dr. Michael Forsting, Head of the Institute for Diagnostic and Interventional Radiology at the University Clinic in Essen. "You can immediately see the condition of the coronary vessels, whether there are emboli sources in the heart and whether vessels in the brain are threatened by blockage."

That includes tiny and ultra-tiny blood vessels. In fact, blockages of these miniature vessels (small vessel diseases) are to blame for twenty to thirty percent of all strokes. They too appear unambiguously on the screen. If detected in time, constrictions of certain vessels can be expanded and others can be rendered passable again with the appropriate drugs.

Enormous gain in precision and speed

These gains have been made possible by the rapid pace of technical progress. Professor Forsting says, "The invention of computer tomography (CT) in the 1970s was the biggest quantum leap forward in medicine since the discovery of antibiotics. Compared to the finely grained images of today with their superb resolution, those earlier ones were little better than simple potato prints. An essential part of this gain in quality can be attributed to the development of multi-slice or multi-detector CTs."

The early CT devices produced just one slice image after another, whereas modern multi-detector systems can take images of up to 64 slices simultaneously. There are usually two scanning and imaging passes. In the first one, images of the bone and organ tissue structures are recorded, and in the second, images of the vascular system following the injection of a contrast medium (CT angiography) are recorded. The enormous improvement in resolution and speed has yielded an abundance of new findings and diagnostic possibilities in recent years.

"Repair procedures made possible today by imaging can mitigate already existing sources of risk in time, but they cannot eliminate the cause of risk," Professor Forsting warned. "In preventive medicine, even the best imaging technique can only be lastingly effective as an early warning system if the patients can be persuaded by the diagnosis to change their lifestyle as well. That means quitting smoking, cutting down on alcohol consumption, switching to a low cholesterol diet, exercising more and doing something about their high blood pressure. The MDCT angiography is an ultra-precise alarm system but it only helps if people listen to it."

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