Cardiac CT Imaging for Ischemic Stroke: Current and Evolving Clinical Applications

Abstract

While the etiology of ischemic stroke is heterogeneous, approximately 20%-40% of all stroke cases result from cardiac or aortic origin. Transesophageal echocardiography (TEE) has become the reference standard modality for the detection of potential sources of cerebral embolism. Because of the advances in computed tomographic (CT) technology, cardiac CT can be used in the evaluation of potential cardioembolic sources. During the past decade, cardiac CT has been tested and compared with TEE for the diagnosis of cardioembolic sources. Many studies showed that cardiac CT is a very useful and powerful modality for the detection of cardioembolic sources, as well as for risk assessment in patients with stroke. Cardiac CT is a reliable alternative imaging modality to TEE for the evaluation of cardioembolic sources in patients with ischemic stroke, avoiding the discomfort and risks associated with TEE. In addition, cardiac CT can be used to simultaneously diagnose coronary artery disease in stroke patients. However, based on current guidelines, cardiac CT is currently not recommended for use in the initial evaluation of intracardiac structures or risk assessment in stroke patients. The aim of this review is to discuss the potential clinical applications of cardiac CT in an ischemic stroke population, focusing on the diagnosis of cardioembolic sources and cardiovascular risk assessment using cardiac CT.