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Updated: Jun 16, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Role of cardiac multidetector computed tomography in acute ischemic stroke: a preliminary report
Sang-Bae Ko1, Sang Il Choi, Eun Ju Chun
1Department of Neurology, Seoul National University Hospital, Seoul, Korea.
Insights
Cardiac multidetector computed tomography (MDCT) is a feasible tool for diagnosing embolic stroke sources in patients with limited cooperation. This study validates its accuracy in acute stroke patients, showing it effectively identifies cardioembolic and aortic sources.
Area of Science:
- Cardiovascular imaging
- Neurology
- Radiology
Background:
- Cardiac multidetector computed tomography (MDCT) may aid in diagnosing embolic sources in patients with limited cooperation due to neurologic deficits.
- Its diagnostic role in acute stroke patients with suspected embolic mechanisms has not been previously validated.
Purpose of the Study:
- To evaluate the feasibility and accuracy of cardiac MDCT in identifying embolic sources in acute ischemic stroke patients.
- To compare the diagnostic yield of cardiac MDCT with transesophageal echocardiography (TEE) in this patient population.
Main Methods:
- Consecutive acute ischemic stroke patients with suspected embolic sources were enrolled.
- Patients underwent transthoracic echocardiography, followed by either cardiac MDCT or TEE.
- Feasibility and results of cardiac MDCT and TEE were compared.
Main Results:
- Cardiac MDCT was performed in 86.7% of patients, TEE in 57.3%.
- Cardiac MDCT identified more high-risk intracardiac (8 vs 1) and extracardiac (20 vs 7) embolic sources compared to TEE.
- Renal insufficiency and lack of cooperation were key limiting factors.
Conclusions:
- Cardiac MDCT is a feasible and accurate imaging modality for detecting embolic sources in acute stroke patients.
- It offers a higher diagnostic yield for cardioembolic and aortic sources compared to TEE in this setting.
Background And Purpose:
Cardiac multidetector computed tomography (MDCT) is less dependent upon the patient's condition and may be valuable in the diagnosis of embolic sources when the patient's cooperation is limited due to a neurologic deficit. However, its role has never been validated in acute stroke patients whose stroke mechanism is assumed to be embolic.
Methods:
Consecutive patients who were admitted with acute ischemic stroke from May 1, 2007 to November 30, 2007 were included in this study. Inclusion criteria were (1) any cardiac evidence of high-risk embolic sources for cerebral embolism, or (2) radiological or (3) clinical evidence of embolic stroke. All patients underwent transthoracic echocardiography first, and then cardiac MDCT or transesophageal echocardiography (TEE) was attempted, if possible. The results and feasibility of cardiac MDCT and TEE were compared.
Results:
One hundred and forty-three patients met the inclusion criteria. Cardiac MDCT was performed in 124 patients (86.7%), TEE in 83 patients (57.3%), whereas 75 patients (52.4%) underwent both studies. Renal insufficiency for cardiac MDCT and lack of cooperation for TEE were found to be the most impeding factors. Among the patients with both evaluations, cardiac MDCT identified a high-risk intracardiac embolic source in 8 and an extracardiac source in 20, while TEE found an intracardiac source in 1 and an extracardiac source in 7. Statistically significant differences were found with respect to detecting cardioembolic sources and high-risk aortic atheroma.
Conclusions:
Cardiac MDCT is a feasible and accurate diagnostic tool for embolic sources in an acute stroke setting.
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