Left atrial appendage thrombi in stroke patients: Detection with two-phase cardiac CT angiography versus transesophageal echocardiography

Jin Hur, Jin Kim Young, Hye Jeong Lee, Jong Won Ha, Hoe Heo Ji, Eui Young Choi, Chi Young Shim, Hoon Kim Tae, Eun Nam Ji, Ok Choe Kyu, Wook Choi Byoung

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)683-690
Number of pages8
JournalRadiology
Volume251
Issue number3
DOIs
Publication statusPublished - 2009 Jun 1

Fingerprint

Atrial Appendage
Transesophageal Echocardiography
Angiography
Thrombosis
Stroke
Research Ethics Committees
Informed Consent
Aorta
Students
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Hur, Jin ; Young, Jin Kim ; Lee, Hye Jeong ; Ha, Jong Won ; Ji, Hoe Heo ; Choi, Eui Young ; Shim, Chi Young ; Tae, Hoon Kim ; Ji, Eun Nam ; Kyu, Ok Choe ; Byoung, Wook Choi. / Left atrial appendage thrombi in stroke patients : Detection with two-phase cardiac CT angiography versus transesophageal echocardiography. In: Radiology. 2009 ; Vol. 251, No. 3. pp. 683-690.
@article{effddd4e28084cf2a3710774bc9d1d71,
title = "Left atrial appendage thrombi in stroke patients: Detection with two-phase cardiac CT angiography versus transesophageal echocardiography",
abstract = "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.",
author = "Jin Hur and Young, {Jin Kim} and Lee, {Hye Jeong} and Ha, {Jong Won} and Ji, {Hoe Heo} and Choi, {Eui Young} and Shim, {Chi Young} and Tae, {Hoon Kim} and Ji, {Eun Nam} and Kyu, {Ok Choe} and Byoung, {Wook Choi}",
year = "2009",
month = "6",
day = "1",
doi = "10.1148/radiol.2513090794",
language = "English",
volume = "251",
pages = "683--690",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

}

Left atrial appendage thrombi in stroke patients : Detection with two-phase cardiac CT angiography versus transesophageal echocardiography. / Hur, Jin; Young, Jin Kim; Lee, Hye Jeong; Ha, Jong Won; Ji, Hoe Heo; Choi, Eui Young; Shim, Chi Young; Tae, Hoon Kim; Ji, Eun Nam; Kyu, Ok Choe; Byoung, Wook Choi.

In: Radiology, Vol. 251, No. 3, 01.06.2009, p. 683-690.

Research output: Contribution to journalArticle

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.

UR - http://www.scopus.com/inward/record.url?scp=67049146759&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67049146759&partnerID=8YFLogxK

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 -