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

Research output: Contribution to journalArticle

64 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2471-2477
Number of pages7
JournalStroke
Volume42
Issue number9
DOIs
Publication statusPublished - 2011 Sep 1

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Atrial Appendage
Transesophageal Echocardiography
Thrombosis
Stroke
Prospective Studies
Radiation
Aorta
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Hur, Jin ; Kim, Young Jin ; Lee, Hye Jeong ; Nam, Ji Eun ; Ha, Jong Won ; Heo, Ji Hoe ; Chang, Hyuk Jae ; Kim, Hua Sun ; Hong, Yoo Jin ; Kim, Hee Yeong ; Choe, Kyu Ok ; Choi, Byoung Wook. / Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke : A prospective comparison study with transesophageal echocardiography. In: Stroke. 2011 ; Vol. 42, No. 9. pp. 2471-2477.
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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.",
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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. / Hur, Jin; Kim, Young Jin; Lee, Hye Jeong; Nam, Ji Eun; Ha, Jong Won; Heo, Ji Hoe; Chang, Hyuk Jae; Kim, Hua Sun; Hong, Yoo Jin; Kim, Hee Yeong; Choe, Kyu Ok; Choi, Byoung Wook.

In: Stroke, Vol. 42, No. 9, 01.09.2011, p. 2471-2477.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke

T2 - A prospective comparison study with transesophageal echocardiography

AU - Hur, Jin

AU - Kim, Young Jin

AU - Lee, Hye Jeong

AU - Nam, Ji Eun

AU - Ha, Jong Won

AU - Heo, Ji Hoe

AU - Chang, Hyuk Jae

AU - Kim, Hua Sun

AU - Hong, Yoo Jin

AU - Kim, Hee Yeong

AU - Choe, Kyu Ok

AU - Choi, Byoung Wook

PY - 2011/9/1

Y1 - 2011/9/1

N2 - 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.

AB - 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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