Heart-to-Brain Multiphasic CT Angiography and Cardiac Screening in Acute Ischemic Stroke—Technical Concepts for CT Cardiac Studies in Stroke Patients

Abstract

Cardiac CT studies to detect embolic sources can be a useful supplement to the imaging armamentarium of acute stroke patients and we explore its possibilities in 2 distinct populations in this technical note. Prior literature has looked at the yield of covering the heart during CT angiography (CTA) in addition to echocardiography and found that it can increase the detection rate of occult embolic sources such as mural thrombus, tumors, and infarcts. The advent of multiphasic CTA for acute stroke patients as part of vascular imaging prior to EVT selection has increased the likelihood of extending coverage or specifically screening the heart in such patients. Additionally, patterns of infarcts and imaging signs can help focus selective patients for dedicated cardiac screening, especially after initial negative echocardiography. We describe the technical aspects of cardiac CT screening in acute stroke patients in this brief report. Future studies in these specific cohorts can confirm the increased yield for early anticoagulation and address modifications for optimal balance with regard to additional radiation exposure.