Purpose Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.

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Background Free‐breathing noncontrast‐enhanced (non‐CE) magnetic resonance angiography (MRA) techniques are of considerable interest for the diagnosis of acute pulmonary embolism (APE), due to the possibility for repeated examinations, avoidance of side effects from iodine‐based contrast agents, and the absence of ionizing radiation exposure as compared to CE‐computed tomographic angiography (CTA). Purpose To analyze the clinical performance of free‐breathing and electrocardiogram (ECG)‐gated radial quiescent‐interval slice‐selective (QISS)‐MRA compared to CE‐CTA and to Cartesian balanced steady‐state free precession (bSSFP)‐MRA. Study Type Prospective. Subjects Thirty patients with confirmed APE and 30 healthy volunteers (HVs). Field Strength/Sequence Radial QISS‐ and bSSFP‐MRA at 1.5T. Assessment Signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio (CNR) were computed to compare the pulmonary imaging quality between MRA methods. The pulmonary arterial tree was divided into 25 branches and an ordinal scoring system was used to assess the image quality of each pulmonary branch. The clinical performance of the two MRA techniques in accurately assessing APE was evaluated with respect to CE‐CTA as the clinical reference standard. Statistical Tests Wilcoxon signed‐rank and Spearman's correlation tests were performed. Sensitivity and specificity of the MRA techniques were determined using CE‐CTA as the clinical reference standard. Results Thrombus‐mimicking artifacts appeared more frequently in lobar and peripheral arteries of patients with Cartesian bSSFP than with radial QISS‐MRA (pulmonary trunk: 12.2% vs. 14.0%, P = 0.64; lobar arteries: 35.6% vs. 22.0%, P = 0.005, peripheral arteries: 74.4% vs. 49.0%, P < 0.001). The relative increases in SNR and of CNR provided by radial QISS‐MRA with respect to Cartesian bSSFP‐MRA were 30–35% (P‐values of SNR/CNR, HVs: 0.09/0.09, patients: 0.03/0.02). The image quality of pulmonary arterial branches was considered good to excellent in 77.2% of patients with radial QISS‐MRA and in 43.2% with Cartesian bSSFP‐MRA (P < 0.0001). The clinical performance of radial QISS‐MRA was higher than Cartesian bSSFP‐MRA for grading embolism, with a total sensitivity of 86.0% vs. 80.6% and a specificity of 93.3% vs. 84.0%, respectively. Data Conclusion Radial QISS‐MRA is a reliable and safe non‐CE angiographic technique with promising clinical potential compared to Cartesian bSSFP‐MRA and as an alternative technique to CE‐CTA for the diagnosis of APE. Level of Evidence 1 Technical Efficacy Stage 3

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