Detection rate of FDG-PET/CT for occult cancer in patients with cryptogenic ischemic stroke

Abstract

Introduction: Cryptogenic stroke represents a third of ischemic strokes and has a significant recurrence rate. Occult cancer has been Identified as a causal factor in up to 5-10% of this type of strokes. We propose that a whole body FDG-PET/CT may increase the detection rate of occult cancer diagnosis in patients with cryptogenic stroke.

Patients and methods: Observational prospective study including patients with cryptogenic ischemic stroke who underwent an FDG-PET/CT scan. Clinical, radiological (three territory sign) and specific analytical measurements (D-dimer) were also informed.

Results: A total of 140 patients were included in the study, with a mean age of 71. The PET scan showed abnormalities in 30% of patients with cryptogenic stroke, with a confirmed cancer diagnosis in 18%. Elevated D-dimer levels and a higher OCCULT-5 score were associated with occult cancer.

Conclusions: Occult cancer was found in 18% of cryptogenic stroke cases in our study, evidenced by whole body FDF-PET/CT scans, which results in significant therapeutic and prognostic implications. Some imaging and analytical determinations seem to have potential for the selection of eligible patients for more advanced examinations.

Keywords: Cryptogenic stroke; PET; Stroke diagnosis.