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Dual-helical CT for detecting aortic atheromas as a source of stroke: comparison with transesophageal
A Tenenbaum1, A Garniek, J Shemesh
1Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Unenhanced dual-helical computed tomography (CT) effectively detects protruding aortic atheromas, offering high accuracy and sensitivity. This rapid, noninvasive imaging method aids in identifying plaques, especially in areas challenging for transesophageal echocardiography (TEE).
Area of Science:
- Cardiovascular Imaging
- Radiology
- Vascular Medicine
Background:
- Protruding aortic atheromas are a significant source of emboli, leading to ischemic stroke and systemic events.
- Accurate detection of these atheromas is crucial for risk stratification and management of cerebrovascular disease.
- Traditional imaging methods like transesophageal echocardiography (TEE) have limitations in visualizing certain aortic segments.
Purpose of the Study:
- To evaluate the utility of unenhanced dual-helical computed tomography (CT) for the rapid, noninvasive detection of protruding aortic atheromas.
- To compare the diagnostic performance of dual-helical CT against TEE in patients with suspected embolic sources.
Main Methods:
- A cohort of 32 patients aged 50 years or older with recent ischemic stroke or systemic emboli underwent both TEE and thin-section unenhanced dual-helical CT.
- CT parameters included a section thickness of 3.2 mm and a reconstruction increment of 1.5 mm.
- Comparative analysis of atheroma detection rates, sensitivity, specificity, and overall accuracy between the two imaging modalities.
Main Results:
- Dual-helical CT demonstrated a sensitivity of 87%, specificity of 82%, and overall accuracy of 84% for detecting protruding aortic atheromas compared to TEE.
- Of 36 atheromas identified by TEE, 34 (94%) were correctly visualized by dual-helical CT, including calcified and hypoattenuating (soft plaque/thrombus) lesions.
- The technique was particularly useful for identifying atheromas in the distal ascending aorta and proximal aortic arch, areas sometimes difficult to assess with TEE.
Conclusions:
- Unenhanced dual-helical CT with thin sections is a valuable tool for the rapid, noninvasive detection of protruding aortic atheromas.
- This imaging modality offers high diagnostic accuracy and can complement TEE, especially in challenging anatomical regions.
- The findings suggest a significant role for dual-helical CT in the etiological investigation of embolic stroke and systemic emboli.
Purpose:
To investigate whether unenhanced dual-helical computed tomography (CT) is useful in the rapid, noninvasive detection of protruding aortic atheromas.
Materials And Methods:
Thirty-two consecutive patients at least 50 years of age who had recent ischemic stroke, systemic emboli, or both, underwent transesophageal echocardiography (TEE) and unenhanced dual-helical CT with thin sections (section thickness, 3.2 mm; reconstruction increment, 1.5 mm).
Results:
TEE demonstrated protruding aortic atheromas 15 patients (47%); dual-helical CT depicted protruding aortic atheromas in 13 of those 15 patients (87%). Of the 17 patients without a protruding aortic atheroma at TEE, dual-helical CT helped confirm the absence in 14 (82%). Dual-helical CT yielded a sensitivity of 87%, a specificity of 82%, and an overall accuracy of 84%. Thirty-six protruding plaques were detected with TEE, of which 34 (94%) were correctly identified with dual-helical CT. Of those 34 plaques, 27 (79%) contained variable amounts of calcium and seven (21%) showed hypoattenuation suggestive of soft plaques and thrombi. In six patients, dual-helical CT depicted a protruding aortic atheroma between the distal ascending aorta and the proximal arch; these plaques were not included in the comparative statistics and were analyzed separately.
Conclusion:
Unenhanced dual-helical CT with thin sections appears to be useful for the rapid, noninvasive detection of a protruding aortic atheroma, especially in areas not clearly visualized with TEE.