Magnetic resonance imaging for diagnostic workup of Embolic Stroke of Undetermined Source: a systematic review

Natallia Khenkina, Alberto Aimo, Iacopo Fabiani, Pier Giorgio Masci, Dimitrios Sagris, Steven E Williams, George Mavraganis, Hui-Sheng Chen, Max Wintermark, Patrik Michel, George Ntaios, Georgios Georgiopoulos

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Embolic stroke of undetermined source, or ESUS, refers to ischemic stroke where the underlying cause of thromboembolism cannot be found despite the recommended diagnostic workup. Unidentified source of emboli hinders clinical decision-making and patient’s management with detrimental consequences on long-term prognosis. Rapid development and versatility of MRI make it an appealing addition to the diagnostic routine of patients with ESUS for the assessment of potential vascular and cardiac embolic sources.
Aims: to review the use of MRI in the identification of cardiac and vascular embolic sources in ESUS and to assess the reclassification value of MRI examinations added to the conventional workup of ESUS
Summary of review: we reviewed the use of cardiac and vascular MRI for the identification of a variety of embolic sources associated with ESUS, including atrial cardiomyopathy, left ventricular pathologies, and supracervical atherosclerosis in carotid and intracranial arteries and in distal thoracic aorta. The additional reclassification after MRI examinations added to the workup of patients with ESUS ranged from 6.1 up to 82.3% and varied depending on the combination of imaging modalities.
Conclusion: MRI techniques allow to identify additional cardiac and vascular embolic sources and may further decrease the prevalence of patients with the diagnosis of ESUS.
Original languageEnglish
JournalInternational Journal of Stroke
Early online date12 Jul 2023
DOIs
Publication statusE-pub ahead of print - 12 Jul 2023

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