Cardiac computed tomographic angiography for detection of cardiac sources of embolism in stroke patients.
OBJECTIVE
We assessed the diagnostic performance of 2-phase 64-slice cardiac computed tomographic angiography (CCTA) for the detection of a cardiac source of embolism in stroke patients using transesophageal echocardiography (TEE) as the reference standard.


METHODS
We selected 137 patients who had experienced a recent episode of stroke and had undergone both 2-phase 64-slice CCTA and TEE within a period of 5 days. A potential cardiac source of embolism detected at both CCTA and TEE was recorded, and echocardiographic findings were categorized into high- and medium-risk sources based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.


RESULTS
Of 137 patients, 100 abnormal findings in 91 patients were found on TEE, and 46 patients had no abnormal finding on TEE. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the 64-slice CCTA for detecting cardiac sources of embolism were 89% (95% CI, 82%, 95%), 100% (95% CI, 90%, 100%), 100% (95% CI, 95%, 100%), and 81% (95% CI, 70%, 92%), respectively. TEE detected a total of 47 high-risk sources of embolism, whereas CT detected 44 lesions. For medium-risk sources of cardiac embolic stroke, TEE detected a total of 53 abnormal findings, whereas CT detected 44 abnormal findings. Of 53 lesions, there were 8 false-negative results on CT (5 patent foramen ovale and 3 atrial septal aneurysm).


CONCLUSIONS
Two-phase 64-slice CCTA is a noninvasive and useful modality for detecting high-risk cardiac sources of embolism in stroke patients.
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
Jin
J
Hur
Young Jin
YJ
Kim
Hye-Jeong
HJ
Lee
Jong-Won
JW
Ha
Ji Hoe
JH
Heo
Eui-Young
EY
Choi
Chi-Young
CY
Shim
Tae Hoon
TH
Kim
Ji Eun
JE
Nam
Kyu Ok
KO
Choe
Byoung Wook
BW
Choi
D000319:Adrenergic beta-Antagonists; D000368:Aged; D003328:Coronary Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011433:Propranolol; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology*; D014057:Tomography, X-Ray Computed
D000319:Adrenergic beta-Antagonists; D011433:Propranolol