Skip to main content
SpringerLink
Log in

Cardiovascular sources of systemic embolism: detection and characterization using multidetector CT and MR imaging

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The purpose of this article is to provide a current review of multidetector CT (MDCT) and MRI findings and imaging protocols for the cardiovascular diseases that can precipitate systemic embolism. These conditions include intracardiac thrombus or tumors, paradoxical embolism through right-to-left shunts, and diseases of the thoracic aorta. MDCT and MRI may be helpful for detection of these conditions. Familiarity with the pathogenesis and CT and MRI appearance of these conditions is important as their detection may have a major impact on patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23

Similar content being viewed by others

References

  1. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE III (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke 24:35–41

    Article  PubMed  Google Scholar 

  2. Sandercock PA, Warlow CP, Jones LN, Starkey IR (1989) Predisposing factors for cerebral infarction: the Oxfordshire community stroke project. BMJ 298:75–80

    Article  PubMed  CAS  Google Scholar 

  3. Raff GL (2010) Radiation dose from coronary CT angiography: five years of progress. J Cardiovasc Comput Tomogr 4:365–374

    Article  PubMed  Google Scholar 

  4. Sommer WH, Albrecht E, Bamberg F, Schenzle JC, Johnson TR, Neumaier K, Reiser MF, Nikolaou K (2010) Feasibility and radiation dose of high-pitch acquisition protocols in patients undergoing dual-source cardiac CT. AJR Am J Roentgenol 195:1306–1312

    Article  PubMed  Google Scholar 

  5. Lu JG, Lv B, Chen XB, Tang X, Jiang SL, Dai RP (2010) What is the best contrast injection protocol for 64-row multi-detector cardiac computed tomography? Eur J Radiol 75:159–165

    Article  PubMed  Google Scholar 

  6. Seng K, Maderwald S, de Greiff A, Quick HH, Laub G, Schmitt P, Barkhausen J, Vogt FM (2010) Dynamic contrast-enhanced magnetic resonance angiography of the thoracic vessels: an intraindividual comparison of different k-space acquisition strategies. Invest Radiol 45:708–714

    Article  PubMed  Google Scholar 

  7. Dewey M, Teige F, Schnapauff D, Laule M, Borges AC, Rutsch W, Hamm B, Taupitz M (2006) Combination of free-breathing and breathhold steady-state free precession magnetic resonance angiography for detection of coronary artery stenoses. J Magn Reson Imaging 23:674–681

    Article  PubMed  Google Scholar 

  8. Witt BJ, Brown RD Jr, Jacobsen SJ, Weston SA, Yawn BP, Roger VL (2005) A community-based study of stroke incidence after myocardial infarction. Ann Intern Med 143:785–792

    PubMed  Google Scholar 

  9. Force CET (1989) Cardiogenic brain embolism. The second report of the cerebral embolism task force. Arch Neurol 46:727–743

    Google Scholar 

  10. Agmon Y, Khandheria BK, Gentile F, Seward JB (2002) Clinical and echocardiographic characteristics of patients with left atrial thrombus and sinus rhythm: experience in 20 643 consecutive transesophageal echocardiographic examinations. Circulation 105:27–31

    Article  PubMed  Google Scholar 

  11. Wolber T, Maeder M, Atefy R, Bluzaite I, Blank R, Rickli H, Ammann P (2007) Should routine echocardiography be performed in all patients with stroke? J Stroke Cerebrovasc Dis 16:1–7

    Article  PubMed  Google Scholar 

  12. Miller SW (2005) Cardiac imaging. In: Thrall JH (ed) Pericardial and myocardial disease, 2nd edn. Elsevier Mosby, Philadelphia, pp 268–269

    Google Scholar 

  13. Hur J, Kim YJ, Lee HJ, Ha JW, Heo JH, Choi EY, Shim CY, Kim TH, Nam JE, Choe KO, Choi BW (2009) Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology 251:683–690

    Article  PubMed  Google Scholar 

  14. Hoey ET, Mansoubi H, Gopalan D, Tasker AD, Screaton NJ (2009) MDCT features of cardiothoracic sources of stroke. Clin Radiol 64:550–559

    Article  PubMed  CAS  Google Scholar 

  15. Kim DH, Choi SI, Choi JA, Chang HJ, Choi DJ, Lim C, Cho JH, Park JH (2006) Various findings of cardiac thrombi on MDCT and MRI. J Comput Assist Tomogr 30:572–577

    Article  PubMed  CAS  Google Scholar 

  16. Hart RG, Foster JW, Luther MF, Kanter MC (1990) Stroke in infective endocarditis. Stroke 21:695–700

    Article  PubMed  CAS  Google Scholar 

  17. Han D, Lee KS, Franquet T, Muller NL, Kim TS, Kim H, Kwon OJ, Byun HS (2003) Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics 23:1521–1539

    Article  PubMed  Google Scholar 

  18. Riding G, Daly K, Hutchinson S, Rao S, Lovell M, McCollum C (2004) Paradoxical cerebral embolisation. An explanation for fat embolism syndrome. J Bone Joint Surg Br 86:95–98

    PubMed  CAS  Google Scholar 

  19. Moriyama Y, Saigenji H, Shimokawa S, Toyohira H, Taira A (1994) The surgical treatment of 30 patients with cardiac myxomas: a comparison of clinical features according to morphological classification. Surg Today 24:596–598

    Article  PubMed  CAS  Google Scholar 

  20. Burke A, Jeudy J Jr, Virmani R (2008) Cardiac tumours: an update: cardiac tumours. Heart 94:117–123

    Article  PubMed  Google Scholar 

  21. Kim EY, Choe YH, Sung K, Park SW, Kim JH, Ko YH (2009) Multidetector CT and MR imaging of cardiac tumors. Korean J Radiol 10:164–175

    Article  PubMed  Google Scholar 

  22. Masui T, Takahashi M, Miura K, Naito M, Tawarahara K (1995) Cardiac myxoma: identification of intratumoral hemorrhage and calcification on MR images. AJR Am J Roentgenol 164:850–852

    PubMed  CAS  Google Scholar 

  23. Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ (2003) Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 146:404–410

    Article  PubMed  Google Scholar 

  24. Caballero PE (2008) Left atrial sarcoma presenting as cerebral infarction. Neurologist 14:131–133

    Article  PubMed  Google Scholar 

  25. Joynt RJ, Zimmerman G, Khalifeh R (1965) Cerebral emboli from cardiac tumors. Arch Neurol 12:84–91

    PubMed  CAS  Google Scholar 

  26. Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG (1994) Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 331:1474–1479

    Article  PubMed  CAS  Google Scholar 

  27. Jones EF, Kalman JM, Calafiore P, Tonkin AM, Donnan GA (1995) Proximal aortic atheroma. An independent risk factor for cerebral ischemia. Stroke 26:218–224

    PubMed  CAS  Google Scholar 

  28. Ko Y, Park JH, Yang MH, Ko SB, Choi SI, Chun EJ, Han MK, Bae HJ (2010) Significance of aortic atherosclerotic disease in possibly embolic stroke: 64-multidetector row computed tomography study. J Neurol 257:699–705

    Article  PubMed  Google Scholar 

  29. Corti R (2006) Noninvasive imaging of atherosclerotic vessels by MRI for clinical assessment of the effectiveness of therapy. Pharmacol Ther 110:57–70

    Article  PubMed  CAS  Google Scholar 

  30. Yim YJ, Choe YH, Ko Y, Kim ST, Kim KH, Jeon P, Byun HS, Kim DI (2008) High signal intensity halo around the carotid artery on maximum intensity projection images of time-of-flight MR angiography: a new sign for intraplaque hemorrhage. J Magn Reson Imaging 27:1341–1346

    Article  PubMed  Google Scholar 

  31. Burke AP, Virmani R (1993) Sarcomas of the great vessels. A clinicopathologic study. Cancer 71:1761–1773

    Article  PubMed  CAS  Google Scholar 

  32. Abularrage CJ, Weiswasser JM, White PW, Arora S, Sidawy AN (2005) Aortic angiosarcoma presenting as distal arterial embolization. Ann Vasc Surg 19:744–748

    Article  PubMed  Google Scholar 

  33. Brylka D, Demos TC, Pierce K (2009) Primary angiosarcoma of the abdominal aorta: a case report and literature review (aortic angiosarcoma). Abdom Imaging 34:239–242

    Article  PubMed  Google Scholar 

  34. Keating EC, Gross SA, Schlamowitz RA, Glassman J, Mazur JH, Pitt WA, Miller D (1983) Mural thrombi in myocardial infarctions. Prospective evaluation by two-dimensional echocardiography. Am J Med 74:989–995

    Article  PubMed  CAS  Google Scholar 

  35. Stratton JR, Resnick AD (1987) Increased embolic risk in patients with left ventricular thrombi. Circulation 75:1004–1011

    Article  PubMed  CAS  Google Scholar 

  36. Crawford TC, WT 4th Smith, Velazquez EJ, Taylor SM, Jollis JG, Kisslo J (2004) Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death. Am J Cardiol 93:500–503

  37. Innelli P, Galderisi M (2004) Which role of echocardiography to predict systemic embolism in dilated cardiomyopathy? Am J Cardiol 94:1479–1480

    Article  PubMed  Google Scholar 

  38. Francois CJ, Schiebler ML, Reeder SB (2010) Cardiac MRI evaluation of nonischemic cardiomyopathies. J Magn Reson Imaging 31:518–530; quiz 517

    Google Scholar 

  39. Oechslin EN, Attenhofer Jost CH, Rojas JR, Kaufmann PA, Jenni R (2000) Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 36:493–500

    Article  PubMed  CAS  Google Scholar 

  40. Petersen SE, Selvanayagam JB, Wiesmann F, Robson MD, Francis JM, Anderson RH, Watkins H, Neubauer S (2005) Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol 46:101–105

    Article  PubMed  Google Scholar 

  41. Tandar A, Meredith KG, Anderson JL (2007) Multiple left ventricular diverticuli in an asymptomatic adult: case report and review of the literature. Catheter Cardiovasc Interv 69:453–458

    Article  PubMed  Google Scholar 

  42. Parthenakis FI, Kochiadakis GE, Patrianakos AP, Hamilos MI, Mitrouska I, Katsamouris AN, Vardas PE (2005) Peripheral arterial embolism due to a left ventricular diverticulum in a young adult. Chest 127:1452–1454

    Article  PubMed  Google Scholar 

  43. Force CET (1986) Cardiogenic brain embolism. Cerebral embolism task force. Arch Neurol 43:71–84

    Google Scholar 

  44. Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 22:983–988

    Article  PubMed  CAS  Google Scholar 

  45. Easton JD, Sherman DG (1980) Management of cerebral embolism of cardiac origin. Stroke 11:433–442

    Article  PubMed  CAS  Google Scholar 

  46. Coulshed N, Epstein EJ, McKendrick CS, Galloway RW, Walker E (1970) Systemic embolism in mitral valve disease. Br Heart J 32:26–34

    Article  PubMed  CAS  Google Scholar 

  47. Rozenshtein A, Boxt LM (2000) Computed tomography and magnetic resonance imaging of patients with valvular heart disease. J Thorac Imaging 15:252–264

    Article  PubMed  CAS  Google Scholar 

  48. Bande D, Abbara S, Kalva SP (2010) Acute renal infarction secondary to calcific embolus from mitral annular calcification. Cardiovasc Intervent Radiol. doi:10.1007/s00270-010-9944-5

  49. Oliveira-Filho J, Massaro AR, Yamamoto F, Bustamante L, Scaff M (2000) Stroke as the first manifestation of calcific aortic stenosis. Cerebrovasc Dis 10:413–416

    Article  PubMed  CAS  Google Scholar 

  50. Budoff MJ, Takasu J, Katz R, Mao S, Shavelle DM, O’Brien KD, Blumenthal RS, Carr JJ, Kronmal R (2006) Reproducibility of CT measurements of aortic valve calcification, mitral annulus calcification, and aortic wall calcification in the multi-ethnic study of atherosclerosis. Acad Radiol 13:166–172

    Article  PubMed  Google Scholar 

  51. Konstantinides S, Geibel A, Kasper W, Olschewski M, Blumel L, Just H (1998) Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation 97:1946–1951

    PubMed  CAS  Google Scholar 

  52. Kim EY, Park JH, Choe YH, Lee SC (2010) Normal variations and anatomic pitfalls that may mimic diseases on coronary CT angiography. Int J Cardiovasc Imaging 26:281–294

    Article  PubMed  Google Scholar 

  53. Kim YJ, Hur J, Choe KO, Choi BW, Shim CY, Choi EY, Kwon HS (2008) Interatrial shunt detected in coronary computed tomography angiography: differential features of a patent foramen ovale and an atrial septal defect. J Comput Assist Tomogr 32:663–667

    Article  PubMed  Google Scholar 

  54. Mohrs OK, Petersen SE, Erkapic D, Rubel C, Schrader R, Nowak B, Fach WA, Kauczor HU, Voigtlaender T (2005) Diagnosis of patent foramen ovale using contrast-enhanced dynamic MRI: a pilot study. AJR Am J Roentgenol 184:234–240

    PubMed  Google Scholar 

  55. Kim H, Choe YH, Park SW, Jun TG, Kang IS, Yang JH, Eo H, Lee HJ (2010) Partially unroofed coronary sinus: MDCT and MRI findings. AJR Am J Roentgenol 195:W331–W336

    Article  PubMed  Google Scholar 

  56. Thaiyananthan NN, Jacono FJ III, Patel SR, Kern JA, Stoller JK (2009) Right-to-left anatomic shunt associated with a persistent left superior vena cava: the importance of injection site in demonstrating the shunt. Chest 136:617–620

    Article  PubMed  Google Scholar 

  57. Remy J, Remy-Jardin M, Wattinne L, Deffontaines C (1992) Pulmonary arteriovenous malformations: evaluation with CT of the chest before and after treatment. Radiology 182:809–816

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant of Korea Health Technology R&D Project, Ministry for Health, Walfare & Family Affairs, Republic of Korea (A102065-26).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology and Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Republic of Korea

    Jiyoung Hwang & Yeon Hyeon Choe

Authors
  1. Jiyoung Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yeon Hyeon Choe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yeon Hyeon Choe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hwang, J., Choe, Y.H. Cardiovascular sources of systemic embolism: detection and characterization using multidetector CT and MR imaging. Int J Cardiovasc Imaging 27, 727–744 (2011). https://doi.org/10.1007/s10554-011-9878-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-011-9878-2

Keywords

Search

Navigation