A Novel Nomogram for the Early Identification of Cardioembolic Stroke Using Clinical and Dual-Energy CT Features

Identifying the etiology of acute ischemic stroke (AIS) is critical for secondary prevention and treatment choice in stroke patients. This study aimed to investigate the dual-energy computed tomography (DECT) quantitative thrombus parameters associated with cardioembolic (CE) stroke and develop a nomogram that combines DECT and clinical data to identify CE stroke.

We retrospectively reviewed all consecutive patients from January 2020 to July 2022 with anterior circulation stroke and proximal intracranial occlusions. Patients were divided into CE stroke and non-cardioembolic (NCE) stroke groups according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Univariable and multivariable logistic analyses were conducted, and a nomogram was developed by combining clinical and DECT variables. This nomogram was subsequently validated using an independent internal cohort of patients.

A total of 96 patients were analyzed, of which 43 (45%) were diagnosed with CE stroke. The multivariable analysis identified the following factors as being independently associated with CE stroke: normalized iodine concentration (NIC) (per 10^-2 unit increase) (odds ratio (OR) = 1.598, 95% CI: 1.277-1.998; p < 0.001), gender (OR = 0.113, 95% CI: 0.028-0.446; p = 0.002), hypertension (OR = 0.204, 95% CI: 0.054-0.770; p = 0.019), and baseline National Institutes of Health Stroke Scale (NIHSS) (OR = 1.168, 95% CI: 1.053-1.296; p = 0.003). The matching nomogram displayed an area under the curve (AUC) of 0.929 in the study sample (n = 96) and 0.899 in the validation cohort (n = 29).

A nomogram that combines clinical and DECT variables can display good diagnostic performance for CE stroke.