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Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography

Authors
 이혜정 ; 장혁재 ; 최규옥 ; 최병욱 ; 하종원 ; 허지회 ; 허진 ; 홍유진 ; 김영진 ; 김화선 ; 김희영 ; 남지은 
Citation
 Stroke, Vol.42(9) : 2471~2477, 2011 
Journal Title
 Stroke 
ISSN
 0039-2499 
Issue Date
2011
Abstract
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/93895
DOI
10.1161/STROKEAHA.110.611293
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
1. 연구논문 > 1. College of Medicine > Dept. of Neurology
1. 연구논문 > 1. College of Medicine > Dept. of Radiology
Yonsei Authors
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