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

Jin Hur1, Young Jin Kim, Hye-Jeong Lee

  • 1Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea.

Radiology
|April 16, 2009
PubMed

Insights

Two-phase cardiac CT angiography accurately detects left atrial appendage thrombi in stroke patients. This noninvasive method effectively differentiates thrombus from stasis, offering high sensitivity and specificity.

Area of Science:

  • Cardiology
  • Radiology
  • Neurology

Background:

  • Left atrial appendage (LAA) thrombi are a significant cause of stroke.
  • Accurate detection of LAA thrombi is crucial for stroke prevention and management.
  • Noninvasive imaging modalities are sought to improve diagnostic capabilities.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of two-phase 64-section cardiac computed tomographic (CT) angiography.
  • To assess its ability to detect LAA thrombi in stroke patients.
  • To differentiate between thrombus and circulatory stasis using cardiac CT angiography, with transesophageal echocardiography (TEE) as the reference standard.

Main Methods:

  • Fifty-five stroke patients underwent both two-phase 64-section cardiac CT angiography and TEE within 5 days.
  • Kappa statistics were used to assess agreement between CT and TEE for thrombus detection.
  • The LAA-ascending aorta attenuation ratio (LAA/AA) was measured on CT images for quantitative analysis.

Main Results:

  • Cardiac CT angiography demonstrated high diagnostic accuracy for LAA thrombi detection, with 100% sensitivity and 98% specificity.
  • High concordance was observed between cardiac CT angiography and TEE (kappa = 0.953).
  • Significantly different LAA/AA values were found between thrombus and circulatory stasis on late-phase CT images (P < .001).

Conclusions:

  • Two-phase 64-section cardiac CT angiography is a sensitive and accurate noninvasive tool for LAA thrombi detection in stroke patients.
  • This imaging technique effectively differentiates thrombus from circulatory stasis.
  • Cardiac CT angiography offers a valuable alternative for evaluating LAA thrombi in this patient population.
Abstract

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