Abstract
To assess the diagnostic accuracy of two-phase 64-section cardiac computed tomographic (CT) angiography for detection of left atrial appendage (LAA) thrombi and differentiation between thrombus and circulatory stasis in patients with stroke, with transesophageal echocardiography (TEE) as the reference standard. This study was institutional review board approved, and all patients gave written informed consent. Fifty-five consecutive patients (36 men, 19 women; mean age, 61 years) who had recently experienced a stroke, had high-risk factors for thrombus formation, and underwent both two-phase 64-section cardiac CT angiography and TEE up to 5 days apart were examined. Agreement between CT and TEE for detection of thrombus was assessed with kappa statistics. For quantitative analysis, the LAA-ascending aorta attenuation ratio (LAA/AA, in Hounsfield units) was measured on early- and late-phase CT images. The significance of differences in CT attenuation measurements were assessed by using the Student t test. A total of 14 thrombi were detected in the 55 patients at TEE. With TEE as the reference standard, the overall sensitivity, specificity, and positive and negative predictive values of cardiac CT angiography for the detection of thrombus in the LAA were 100% (14 of 14 patients), 98% (40 of 41 patients), 93% (14 of 15 patients), and 100% (40 of 40 patients), respectively. Concordance between cardiac CT angiography and TEE for the detection of thrombus in the LAA was high (overall kappa = 0.953). Mean LAA/AA values were significantly different between thrombus (0.29 HU +/- 0.12 [standard deviation]) and circulatory stasis (0.85 HU +/- 0.12) on late-phase CT images (P < .001). Two-phase 64-section cardiac CT angiography is a noninvasive sensitive modality for detecting LAA thrombi and differentiating thrombus from circulatory stasis in stroke patients.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.