Stroke of undetermined aetiology or ‘cryptogenic’ stroke accounts for 30–40% of ischaemic strokes despite extensive diagnostic evaluation. The role and yield of cardiac imaging is controversial. Cardiac MRI (CMR) has been used for cardiac disorders, but its use in cryptogenic stroke is not well established. We reviewed the literature (randomised trials, exploratory comparative studies and case series) on the use of CMR in the diagnostic evaluation of patients with ischaemic stroke. The literature on the use of CMR in the diagnostic evaluation of ischaemic stroke is sparse. However, studies have demonstrated a potential role for CMR in the diagnostic evaluation of patients with cryptogenic stroke to identify potential aetiologies such as cardiac thrombi, cardiac tumours, aortic arch disease and other rare cardiac anomalies. CMR can also provide data on certain functional and structural parameters of the left atrium and the left atrial appendage which have been shown to be associated with ischaemic stroke risk. CMR is a non-invasive modality that can help identify potential mechanisms in cryptogenic stroke and patients who may be targeted for enrolment into clinical trials comparing anticoagulation to antiplatelet therapy in secondary stroke prevention. Prospective studies are needed to compare the value of CMR as compared to transthoracic and transesophageal echocardiography in the diagnostic evaluation of cryptogenic stroke.
- CEREBROVASCULAR DISEASE
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Contributors SY, ALL and MA contributed to drafting the manuscript and involved in literature review. KLF involved in critical revision of the manuscript. HK contributed to drafting the manuscript and critical revision. RAB contributed to critical revision and supervision.
Funding SY received funding from the New York Stroke Trials Network of Columbia and Cornell (NYCCSTN, NINDS U10NS086728). ALL was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number 1U10NS086474.
Competing interests HK received funding from the NIH and is a speaker for Genentech. RAB provides consulting services and sits on the advisory committee for Medtronic, Beohringer Ingelheim and Pfizer/BMS. MA, CS and KLF have no disclosures.
Provenance and peer review Not commissioned; externally peer reviewed.