Dual-Enhanced Cardiac CT for Detection of Left Atrial Appendage Thrombus in Patients With Stroke: A Prospective Comparison Study With Transesophageal Echocardiography

• Published in: Stroke (1970) Vol. 42; no. 9; pp. 2471 - 2477
• Main Authors: HUR, Jin, YOUNG JIN KIM, KYU OK CHOE, BYOUNG WOOK CHOI, LEE, Hye-Jeong, JI EUN NAM, HA, Jong-Won, JI HOE HEO, CHANG, Hyuk-Jae, HUA SUN KIM, YOO JIN HONG, HEE YEONG KIM
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.09.2011
• Subjects: Adult; Aged; Aged, 80 and over; Atrial Appendage - diagnostic imaging; Atrial Appendage - ultrastructure; Biological and medical sciences; Echocardiography, Transesophageal - methods; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Prospective Studies; Sensitivity and Specificity; Thrombosis - diagnostic imaging; Tomography, X-Ray Computed - methods; Vascular diseases and vascular malformations of the nervous system; Human; dual-source cardiac computed tomography (DSCT); Stroke; Nervous system diseases; Echocardiography; Cardiovascular disease; Medical screening; thrombus; Cerebral disorder; Vascular disease; Central nervous system disease; Computerized axial tomography; transesophageal echocardiography; Comparative study; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.110.611293

A noninvasive method with high reliability and accuracy comparable to transesophageal echocardiography for identification of left atrial appendage thrombus would be of significant clinical value. The aim of this study was to assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. We studied 83 consecutive patients with stroke (56 men and 27 women; mean age, 62.6 years) who had high risk factors for thrombus formation and had undergone both dual-source CT and transesophageal echocardiography within a 3-day period. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. Among the 83 patients, a total of 13 thrombi combined with spontaneous echo contrast and 14 spontaneous echo contrasts were detected by transesophageal echocardiography. All 13 thrombi combined with spontaneous echo contrast were correctly diagnosed on CT. Using transesophageal echocardiography as the reference standard, the overall sensitivity and specificity of CT for the detection of thrombi and circulatory stasis in the left atrial appendage were 96% (95% CI, 78% to 99%), and 100% (95% CI, 92% to 100%), respectively. On CT, the mean left atrial appendage/ascending aorta Hounsfield unit ratios were significantly different between thrombus and circulatory stasis (0.15 Hounsfield unit versus 0.27 Hounsfield unit, P=0.001). The mean effective radiation dose was 3.11 mSv. Dual-enhanced cardiac CT with prospective electrocardiographic gating is a noninvasive and sensitive modality for detecting left atrial appendage thrombus with an acceptable radiation dose.