Dual-helical CT for detecting aortic atheromas as a source of stroke: comparison with transesophageal echocardiography.
OBJECTIVE
To investigate whether unenhanced dual-helical computed tomography (CT) is useful in the rapid, noninvasive detection of protruding aortic atheromas.


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.


CONCLUSIONS
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.
Tenenbaum
A
A
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Garniek
A
A
Shemesh
J
J
Fisman
E Z
EZ
Stroh
C I
CI
Itzchak
Y
Y
Vered
Z
Z
Motro
M
M
D001011:Aorta / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001027:Aortography; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D002114:Calcinosis / Q000000981:diagnostic imaging; D002118:Calcium; D002561:Cerebrovascular Disorders / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D017700:Embolism, Cholesterol / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*
D002118:Calcium