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Impact of Implementing Cardiac CT in Evaluating Patients Suspected of Cardioembolic Stroke
Amr M Ajlan1, Rabab R Bagdadi, Mohamed Nabil Alama
1From the *Cardiothoracic Imaging Unit, Radiology Department, King Abdulaziz University Hospital, King Abdulaziz University; †Radiology Department, Ministry of Health; and ‡Cardiology Unit, Internal Medicine Department, and §Neurology Division, Internal Medicine Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Western Region, Saudi Arabia.
Insights
Cardiac computed tomography (CT) aids in diagnosing cardioembolic stroke by identifying embolic sources missed by echocardiography. This noninvasive imaging also detects significant stroke-unrelated findings and coronary artery disease (CAD).
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Transesophageal echocardiography (TEE) is often challenging in stroke patients due to clinical and logistical barriers.
- Cardiac computed tomography (CT) is a noninvasive alternative for detecting embolic causes of stroke.
- This study evaluated the added value of cardiac CT in the work-up of suspected cardioembolic stroke.
Purpose of the Study:
- To assess the diagnostic utility of cardiac CT in identifying embolic sources in patients with suspected cardioembolic stroke.
- To evaluate the detection of stroke-unrelated findings and coronary artery disease (CAD) by cardiac CT.
- To compare cardiac CT findings with echocardiographic reports in this patient cohort.
Main Methods:
- Retrospective evaluation of cardiac CT images and reports from 47 patients referred for suspected cardioembolic stroke.
- Assessment of cardiac CT for major embolic potential findings, stroke-unrelated findings, and CAD.
- Correlation of CT results with existing echocardiographic reports.
Main Results:
- Cardiac CT identified major embolic potential findings in 10 patients (21%), including thrombi, vasculitis, and arteriovenous malformations, not seen on echocardiography.
- Echocardiography identified 2 cases (4%) of major embolic potential (atrial appendage thrombus, mitral valve vegetation) not detected by CT.
- Cardiac CT revealed significant stroke-unrelated findings in 28% of patients and unexpected coronary artery disease (CAD) in 47%, with 52% of CAD being obstructive.
Conclusions:
- Cardiac CT offers added value to echocardiography in the assessment of suspected cardioembolic stroke.
- Cardiac CT effectively detects major embolic sources and provides additional information on stroke-unrelated pathologies and CAD.
- The integration of cardiac CT can enhance the diagnostic yield in the evaluation of cardioembolic stroke.
Background And Objectives:
In practice, clinical and logistic hurdles may hamper performing transesophageal echocardiography in stroke patients. Cardiac computed tomography (CT) is a recently introduced noninvasive modality able to detect various embolic causes. Thus, we retrospectively assessed possible added values of applying cardiac CT in the real-world work-up of suspected cardioembolic stroke cases.
Methods:
Forty-seven patients were neurology service referrals for suspected cardioembolic stroke. The CT images and clinical reports of our cardiac CT radiologists were retrospectively evaluated. Cardiac CT was assessed in terms of detecting major embolic potential findings, potentially significant stroke-unrelated findings, and coronary arterial disease (CAD). Computed tomography results were correlated with echocardiographic reports.
Results:
Cardiac CT showed findings of major embolic potential in 10 patients (21%, 5 thrombi cases, 2 vasculitis cases, 1 case of metastasis invading the left superior pulmonary artery, 1 myocardial infarction case, and 1 pulmonary arteriovenous malformations case), none of which were documented in echocardiography reports. Two cases (4%) with findings of major embolic potential where identified on echocardiography but not on CT (1 left atrial appendage thrombus and 1 mitral valve vegetation). Computed tomography of 13 patients (28%) showed 16 potentially significant stroke-unrelated findings. Twenty-one patients (47%) had unexpected CAD on CT, 11 (52%) of which were obstructive.
Conclusions:
Implementing cardiac CT in assessing patients suspected of cardioembolic stroke added value to echocardiographic evaluation, by detecting major embolic potential findings. In addition, cardiac CT revealed additional potentially significant stroke-unrelated findings and CAD.
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