Academic Editor: Peter A. McCullough
Background: Hyperacute cardiac imaging of patients with acute
ischemic stroke (AIS), though desirable, is impractical. Using
delayed-enhancement, low-dose, non-gated, chest spectral computed tomography
scans (DESCT), we explored the prevalence and patterns of incidental myocardial
late iodine enhancement (LIE) and embolic sources, and their relationship with
stroke etiology. Methods: Since July 2020, DESCT was performed after
cerebrovascular CT angiography (CTA) among patients with suspected AIS undergoing
CT using a dual-layer spectral scanner, without additional contrast
administration. Images were analyzed using monoenergetic reconstructions and
iodine density maps, and the myocardial extracellular volume fraction (ECV, %)
was calculated. Results: Eighty patients with AIS were included. DESCT
identified a cardiac thrombi in 6 patients (7.5%), and a complex aortic plaque
in 4 (5%) cases; reclassifying 5 embolic strokes of uncertain source (28% of
ESUS) to cardioembolic (CE, n = 3) and non-CE (n = 2) etiologies. LIE was
identified in 38 (48%) patients, most commonly (82%) of ischemic pattern. We
did not identify significant relationships between AIS etiology and the presence,
pattern, and extent of LIE (p