Spectral cardiac CT in acute stroke patients
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Published on: September 25, 2019
Naomi Larsen1, Friederike Austein2,3, Tristan Klintz2
1Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. naomi.larsen@uksh.de.
Insights
Spectral cardiac CT improves detection of cardiac thrombi in acute stroke patients. This advanced imaging technique enhances diagnostic certainty and contrast compared to conventional CT, aiding secondary prevention strategies.
Area of Science:
- Cardiology
- Radiology
- Neurology
Background:
- Cardiac CT in acute ischemic stroke aids in identifying embolism sources and guiding prevention.
- Spectral CT offers potential for improved contrast between thrombi and cardiac structures.
Purpose of the Study:
- To evaluate the diagnostic value of spectral cardiac CT versus conventional CT for detecting cardiac thrombi in acute stroke patients.
Main Methods:
- Retrospective analysis of acute ischemic stroke patients who underwent spectral cardiac CT.
- Evaluation of conventional CT, virtual 55 keV monoenergetic (monoE55), z-effective (zeff), and iodine density images for thrombi.
- Assessment of diagnostic certainty using a 5-point Likert scale and calculation of contrast ratios.
Main Results:
- Four thrombi missed on conventional CT were detected on spectral reconstructions.
- MonoE55 images yielded the highest diagnostic certainty scores.
- Iodine density images showed the highest contrast ratios, followed by monoE55, conventional, and zeff images (p < 0.005).
Conclusions:
- Spectral cardiac CT provides added diagnostic benefit for detecting intra-cardiac thrombi in acute ischemic stroke patients.
- The technique enhances visualization and detection rates compared to conventional CT.
Abstract:
Cardiac CT obtained in acute ischemic stroke patients can facilitate timely detection of cardiac sources of embolism and guide secondary prevention strategies. Spectral CT exploiting the simultaneous acquisition of separate higher-energy and lower-energy photon spectrum datasets has the potential to improve contrast between thrombi and cardiac structures. This study aimed to investigate the diagnostic value of spectral cardiac CT compared to conventional CT for the detection of cardiac thrombi in acute stroke patients. Patients with acute ischemic stroke undergoing spectral cardiac CT were retrospectively included. Conventional CT images, virtual 55 keV monoenergetic (monoE55), z-effective (zeff), and iodine density images were evaluated for the presence of thrombi. Diagnostic certainty was rated on a 5-point Likert scale. Contrast ratios were calculated for all reconstructions. 63 patients with 20 thrombi were included. Four thrombi were missed on conventional images but detected on spectral reconstructions. MonoE55 achieved the highest scores for diagnostic certainty. Contrast ratios were highest on iodine density images, followed by monoE55, conventional and zeff (p < 0.005). Spectral cardiac CT adds diagnostic benefit for the detection of intra-cardiac thrombi in acute ischemic stroke patients compared to conventional CT.
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