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Updated: Aug 5, 2026

Integrated Photoacoustic, Ultrasound, and Angiographic Tomography (PAUSAT) for NonInvasive Whole-Brain Imaging of Ischemic Stroke
06:45

Integrated Photoacoustic, Ultrasound, and Angiographic Tomography (PAUSAT) for NonInvasive Whole-Brain Imaging of Ischemic Stroke

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Cardiac photon-counting detector computed tomography in acute ischemic stroke: diagnostic accuracy for detection of

Annemarie Kirschfink1, Mohamed Elhalal2, Stefan Seidel3

  • 1Department of Internal Medicine I (Cardiology), University Hospital RWTH Aachen, Aachen, Germany.

Therapeutic Advances in Neurological Disorders
|August 1, 2026
PubMed

Insights

Photon-counting detector CT (PCD-CT) effectively detects left atrial appendage (LAA) thrombus in stroke patients. This imaging technique shows high accuracy, potentially ruling out LAA thrombus in acute stroke workups.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Up to 33% of ischemic stroke cases remain without a clear cause.
  • The left atrial appendage (LAA) is a common source of cardiac emboli but is often under-evaluated in stroke diagnostics.
  • Identifying the source of embolism is crucial for effective stroke prevention strategies.

Purpose of the Study:

  • To assess the diagnostic accuracy of cardiac photon-counting detector computed tomography (PCD-CT) for detecting LAA thrombus.
  • To evaluate the utility of integrating PCD-CT into acute stroke imaging protocols.
  • To compare PCD-CT findings with transesophageal echocardiography (TEE) as the gold standard.

Main Methods:

  • A retrospective diagnostic accuracy study included 101 patients with acute ischemic stroke or TIA.
  • Patients underwent emergent cardiac PCD-CT and TEE between 2023 and 2025.
  • Diagnostic performance metrics for PCD-CT in identifying LAA thrombus were calculated against TEE results.

Main Results:

  • LAA thrombus was identified in 12% of patients by PCD-CT.
  • Patients with LAA thrombus were older and had higher rates of atrial fibrillation.
  • PCD-CT demonstrated high diagnostic accuracy (96%), sensitivity (90%), specificity (97%), PPV (75%), and NPV (99%) for LAA thrombus detection.

Conclusions:

  • Cardiac PCD-CT, when integrated into acute stroke imaging, is a valuable tool for LAA thrombus detection.
  • The study suggests PCD-CT can reliably exclude the presence of LAA thrombus.
  • This technique may improve the etiological workup of ischemic stroke.
Abstract

Keywords:
computed tomographyintracardiac thrombusleft atrial appendagephoton-counting detectorstroketransesophageal echocardiography

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