What are Risk Factors for Stroke? Imaging Assessment of Cardiovascular Risk in Stroke

1) Understand the stroke subtype and the risk factors of cardio-embolic stroke. 2) Describe the imaging modalities in the assessment of cardiovascular risk in stroke patients. 3) Describe the advantages and disadvantages of cardiac CT and MRI in the use of assessing cardio-embolic sources in stroke patient. 4) Discuss the prognostic value of cardiac CT for risk stratification in stroke patients. This session is part of Korea Presents at RSNA 2014.

Cardiogenic emboli have been estimated to be the causative factor in 20% to 40% of all stroke cases. Therefore, identification of a cardiac source of embolism in stroke patients is important for proper therapeutic management. Currently, transesophageal echocardiography (TEE) is considered the reference standard method for the detection of potential sources of cerebral embolism. TEE offers high resolution images of the left atrium (LA) and its appendage as well as the thoracic aorta for the evaluation of left atrial blood stasis and aortic atherosclerosis. Although TEE is widely available, it is a semi-invasive test, usually performed under conscious sedation. In current clinical practice, there is a need for a less invasive modality that is capable of assessing the cardiovascular system for embolic stroke patients. Cardiac magnetic resonance imaging (MRI) is an appealing modality to evaluate a suspected embolic stroke patient. Cardiac MRI can adequately image potential embolic sources such as LV thrombi, cardiac masses, aortic plaques or LAA thrombi. Recently introduced multidetector computed tomography (MDCT) with subsecond rotation times and a dedicated cardiac reconstruction algorithm can acquire 3-dimensional data of the heart, enabling detailed visualization of not only the coronary arteries but also other cardiac structures such as the left atrial appendage (LAA), myocardium, valves, and septa.; Therefore, MDCT can play a significant role as a noninvasive procedure in the detection of the cardioembolic origin of stroke. Radiologists should be familiar with their imaging features as identification has significant management and prognostic implications.

SPCP21B

What are Risk Factors for Stroke? Imaging Assessment of Cardiovascular Risk in Stroke