1Rodrigo Lauretto,3Maria Victoria Abuchaim Campos,3Guilherme Guissone Martins,1André Bouquet Ferreira da Silva,2Breno Nunes Nogueira,1Maria Eduarda Rodrigues Vale,2Isabelly Sant’Ana de Almeida,2Thais Lemos de Oliveira Silva,2Vitória de Almeida Rolim Rabelo,2Vitor Dácio Medeiros,1Bárbara Fernandes Dias dos Santos,1Maria Layana de Queiroz Oliveira,1Tiago Abreu de Morais,1Sarah Campos de Angelo,1Luiza Nogueira de Souza Paz,3Filipe JL Garcia,4Liliana M. Occulate,5Amanda Batista Ferreira da Silva,3Délio Tiago Martins Malaquias,3Lucas de Souza Vieira,6Mateus Soares Santos Araújo,6João Marcelo Vieira Morais,6Rodrigo dos Santos Oliveira Alves,7Vinicius Lopes Alves,8*Thiago Augusto Rochetti Bezerra,3Erik Franklin A Silva,7Andréa Pereira da Silva,9Fabricio Uchôa Garcia,9Sadrak Horácio Cassoma
1Nove de Julho University (UNINOVE), Mauá Campus, Mauá, São Paulo, Brazil.
2University of Western São Paulo (UNOESTE), Guarujá Campus, Guarujá, São Paulo, Brazil.
3University of Ribeirão Preto (UNAERP), Guarujá Campus, Guarujá, São Paulo, Brazil.
4Central University of Paraguay (UCP), School of Medicine, Pedro Juan Caballero, Paraguay.
5Federal University of Roraima (UFRR), Boa Vista, Roraima, Brazil.
6Euro-American University Center (UNIEURO), Brasília, Federal District, Brazil.
7University of the Integration of the Americas (UNIDA), Paraguay.
8Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil.
9Faculty of the Americas (FAM), São Paulo, Brazil.
ABSTRACT
Ischemic stroke (IS) is a time-dependent neurological emergency in which imaging methods play a fundamental role from initial diagnosis through etiological investigation and secondary prevention. The aim of this review was to analyze the contribution of neuroimaging, vascular assessment, and cardiovascular imaging to the management of ischemic stroke. This is a descriptive and analytical systematic literature review conducted according to the PRISMA 2020 recommendations. PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, BVS, and SciELO were searched, prioritizing publications from 2021 to 2026. The results showed that non-contrast computed tomography remains the main initial method for excluding hemorrhage and assessing early ischemic changes, whereas CT angiography plays a decisive role in identifying large-vessel occlusions and planning thrombectomy. CT perfusion and magnetic resonance imaging expand the assessment of the ischemic core, penumbra, and tissue viability, particularly in late therapeutic windows or when onset time is unknown. In cardiovascular investigation, echocardiography remains central and is complemented by cardiac computed tomography and magnetic resonance imaging for identifying intracardiac thrombi, cardiomyopathies, interatrial septal abnormalities, and aortic sources of embolism. It is concluded that the ideal approach should be multimodal and individualized, integrating cerebral, vascular, and cardiovascular findings. Rational and sequential use of imaging methods can optimize reperfusion, improve etiological accuracy, and guide secondary prevention strategies in ischemic stroke.
KEYWORDS
Ischemic Stroke; Neuroimaging; Computed Tomography; Magnetic Resonance Imaging; Echocardiography; Cardiac Embolism; Secondary Prevention.
REFERENCES
1) CANALI, Emanuele; SERANI, Marco; TARZIA, Pierpaolo; CIAMPI, Pellegrino; CANESTRELLI, Stefano; CALÒ, Leonardo. Echocardiography in cardioembolic stroke prevention. European Heart Journal Supplements, v. 25, supl. C, p. C212-C217, 2023. DOI: https://doi.org/10.1093/eurheartjsupp/suad022.
2) DHILLON, Permesh Singh; MAREI, Omar; PODLASEK, Anna; BUTT, Waleed; RICE, Hal; DE VILLIERS, Laetitia; DO NASCIMENTO, Vinicius Carraro; MCCONACHIE, Norman; LENTHALL, Robert; NAIR, Sujit; MALIK, Luqman; BHOGAL, Pervinder; DINEEN, Robert A.; ENGLAND, Timothy J. Endovascular thrombectomy vs best medical management for late presentation acute ischaemic stroke with large vessel occlusion without CT perfusion or MR imaging selection: a systematic review and meta-analysis. Journal of Stroke and Cerebrovascular Diseases, v. 33, n. 11, p. 108002, 2024. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108002.
3) GHOZY, Sherief; LIU, Michael; KOBEISSI, Hassan; MORTEZAEI, Ali; AMOUKHTEH, Melika; ABBAS, Alzhraa S.; DMYTRIW, Adam A.; KADIRVEL, Ramanathan; RABINSTEIN, Alejandro A.; KALLMES, David F.; NASR, Deena. Cardiac CT vs echocardiography for intracardiac thrombus detection in ischemic stroke: a systematic review and meta-analysis of 43 studies. Neurology, v. 103, n. 7, p. e209771, 2024. DOI: https://doi.org/10.1212/WNL.0000000000209771.
4) NTAIOS, George; BAUMGARTNER, Helmut; DOEHNER, Wolfram; DONAL, Erwan; EDVARDSEN, Thor; HEALEY, Jeff S.; IUNG, Bernard; KAMEL, Hooman; KASNER, Scott E.; KOROMPOKI, Eleni; NAVI, Babak B.; PRISTIPINO, Christian; SABA, Luca; SCHNABEL, Renate B.; SVENNBERG, Emma; LIP, Gregory Y. H. Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC. European Heart Journal, v. 45, n. 19, p. 1701-1715, 2024. DOI: https://doi.org/10.1093/eurheartj/ehae150.
5) PAGE, Matthew J.; MCKENZIE, Joanne E.; BOSSUYT, Patrick M.; BOUTRON, Isabelle; HOFFMANN, Tammy C.; MULROW, Cynthia D. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, v. 372, p. n71, 2021. DOI: https://doi.org/10.1136/bmj.n71.
6) PANICKER, Sreehari; WILSECK, Zachary M.; LIN, Leanne Y.; GEMMETE, Joseph J. CT imaging computed tomography/computed tomography angiography/perfusion in acute ischemic stroke and vasospasm. Neuroimaging Clinics of North America, v. 34, n. 2, p. 175-189, 2024. DOI: https://doi.org/10.1016/j.nic.2024.01.004.
7) PRABHAKARAN, Shyam; GONZALEZ, Nestor R.; ZACHRISON, Kori S.; ADEOYE, Opeolu; ALEXANDROV, Anne W.; ANSARI, Sameer A. et al. 2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association/American Stroke Association. Stroke, v. 57, n. 8, p. e316-e436, 2026. DOI: https://doi.org/10.1161/STR.0000000000000513.
8) RINKEL, Leon A.; GUGLIELMI, Valeria; BEEMSTERBOER, Chiel F. P.; GROENEVELD, Nina-Suzanne; LOBÉ, Nick H. J.; BOEKHOLDT, S. Matthijs; BOUMA, Berto J.; MULLER, Fenna F.; BEENEN, Ludo F. M.; MARQUERING, Henk A.; MAJOIE, Charles B. L. M.; ROOS, Yvo B. W. M.; VAN RANDEN, Adrienne; PLANKEN, R. Nils; COUTINHO, Jonathan M. Diagnostic yield of ECG-gated cardiac CT in the acute phase of ischemic stroke vs transthoracic echocardiography. Neurology, v. 99, n. 14, p. e1456-e1464, 2022. DOI: https://doi.org/10.1212/WNL.0000000000200995.
9) SARRAJ, Amrou; PUJARA, Deep K.; CAMPBELL, Bruce C. V. Current state of evidence for neuroimaging paradigms in management of acute ischemic stroke. Annals of Neurology, v. 95, n. 6, p. 1017-1034, 2024. DOI: https://doi.org/10.1002/ana.26925.
10) SHAH, Shamik; MALIK, Preeti; PATEL, Urvish; WANG, Yunxia; GRONSETH, Gary S. Diagnostic yield of TEE in patients with cryptogenic stroke and TIA with normal TTE: a systematic review and meta-analysis. Neurology International, v. 13, n. 4, p. 659-670, 2021. DOI: https://doi.org/10.3390/neurolint13040063.
11) VAN DER MATEN, Gerlinde; DIJKSTRA, Saskia; MEIJS, Matthijs F. L.; VON BIRGELEN, Clemens; VAN DER PALEN, Job; DEN HERTOG, Heleen M. Cardiac imaging in ischemic stroke or transient ischemic attack of undetermined cause: systematic review & meta-analysis. International Journal of Cardiology, v. 339, p. 211-218, 2021. DOI: https://doi.org/10.1016/j.ijcard.2021.06.047.
12) XIAO, Jiayu; POBLETE, Roy A.; LERNER, Alexander; NGUYEN, Peggy L.; SONG, Jae W.; SANOSSIAN, Nerses; WILCOX, Alison G.; SONG, Shlee S.; LYDEN, Patrick D.; SAVER, Jeffrey L.; WASSERMAN, Bruce A.; FAN, Zhaoyang. MRI in the evaluation of cryptogenic stroke and embolic stroke of undetermined source. Radiology, v. 311, n. 1, p. e231934, 2024. DOI: https://doi.org/10.1148/radiol.231934.
Cite this article
Lauretto, R., Campos, M. V. A., Martins, G. G., Silva, A. B. F. D., Nogueira, B. N., Vale, M. E. R., Almeida, I. S. D., Silva, T. L. D. O., Rabelo, V. D. A. R., Medeiros, V. D., Santos, B. F. D. D., Oliveira, M. L. D. Q., Morais, T. A. D., Angelo, S. C. D., Paz, L. N. D. S., Garcia, F. J., Occulate, L. M., Silva, A. B. F. D., Malaquias, D. T. M., Cassoma, S. H. (2026). Role of Radiology in the Cardiovascular and Neurological Investigation of Ischemic Stroke. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(10), 1094-1110. https://doi.org/10.58806/ijhmr.2026.v5i10n13
