TY - JOUR
T1 - Left atrial appendage thrombi in stroke patients
T2 - Detection with two-phase cardiac CT angiography versus transesophageal echocardiography
AU - Hur, Jin
AU - Young, Jin Kim
AU - Lee, Hye Jeong
AU - Ha, Jong Won
AU - Ji, Hoe Heo
AU - Choi, Eui Young
AU - Shim, Chi Young
AU - Tae, Hoon Kim
AU - Ji, Eun Nam
AU - Kyu, Ok Choe
AU - Byoung, Wook Choi
PY - 2009/6/1
Y1 - 2009/6/1
N2 - Purpose: 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. Materials and Methods: 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 κ 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. Results: 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 κ = 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). Conclusion: 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.
AB - Purpose: 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. Materials and Methods: 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 κ 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. Results: 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 κ = 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). Conclusion: 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.
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U2 - 10.1148/radiol.2513090794
DO - 10.1148/radiol.2513090794
M3 - Article
C2 - 19366905
AN - SCOPUS:67049146759
VL - 251
SP - 683
EP - 690
JO - Radiology
JF - Radiology
SN - 0033-8419
IS - 3
ER -