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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

 Jin Hur  ;  Young Jin Kim  ;  Hye-Jeong Lee  ;  Ji Eun Nam  ;  Jong-Won Ha  ;  Ji Hoe Heo  ;  Hyuk-Jae Chang  ;  Hua Sun Kim  ;  Yoo Jin Hong  ;  Hee Yeong Kim  ;  Kyu Ok Choe  ;  Byoung Wook Choi 
 Stroke, Vol.42(9) : 2471-2477, 2011 
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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.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김영진(Kim, Young Jin) ; 김화선(Kim, Hua Sun) ; 김희영(Kim, Hee Yeong) ; 남지은(Nam, Ji Eun) ; 이혜정(Lee, Hye Jeong) ; 장혁재(Chang, Hyuck Jae) ; 최규옥(Choe, Kyu Ok) ; 최병욱(Choi, Byoung Wook) ; 하종원(Ha, Jong Won) ; 허지회(Heo, Ji Hoe) ; 허진(Hur, Jin) ; 홍유진(Hong, Yoo Jin)
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