ORIGINAL PAPER Cardiovascular sources of systemic embolism: detection and characterization using multidetector CT and MR imaging Jiyoung Hwang • Yeon Hyeon Choe Received: 10 April 2011 / Accepted: 15 April 2011 / Published online: 3 May 2011 Ó Springer Science+Business Media, B.V. 2011 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. Keywords Multidetector CT Á MR imaging Á Stroke Á Embolism Á Heart Introduction Embolism of cardiac and aortic origin accounts for 20–25% of ischemic strokes [1, 2]. Emboli of cardiac and aortic origin include thrombus in the left atrium (LA), LA appendage (LAA), left ventricle (LV), cardiac tumors, vegetation, air/fat embolism, aortic atheroma and thrombus, and aortic sarcoma. Cardiac conditions favoring embolism are ischemic cardio- myopathy, non-ischemic cardiomyopathy, LV myo- cardial noncompaction, atrial fibrillation (AF), valvular disease such as mitral stenosis (MS) or aortic stenosis (AS), and intracardiac/extracardiac shunts including atrial septal defect (ASD), ventricular septal defect (VSD), patent foramen ovale (PFO), unroofed coronary sinus, and pulmonary arteriovenous malfor- mation. These conditions may cause potentially deadly cerebral or myocardial infarction (MI) or occlusion of arteries in the upper or lower extremities by systemic arterial embolism. However, their diag- nosis is difficult and frequently presumptive in clinical practice, but also important because many cardiogenic sources of systemic emboli are potentially identifiable and preventable prior to stroke. Cardiac multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) enables noninvasive imaging of cardiac structures, including coronary arteries, and evaluation of cardiac function, and can play significant roles in the detection of the cardiothoracic conditions that can precipitate systemic embolism. This article describes the MDCT and MRI findings of cardiovascular conditions that may cause systemic embolism. Multidetector CT techniques Cardiac MDCT opened a new era of cardiac imaging. With high-resolution images, its short scan time, J. Hwang Á Y. H. Choe (&) 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 e-mail: yhchoe@skku.edu 123 Int J Cardiovasc Imaging (2011) 27:727–744 DOI 10.1007/s10554-011-9878-2