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(Stroke. 2009;40:2073.)
© 2009 American Heart Association, Inc.

Original Contributions

Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients

Jin Hur, MD; Young Jin Kim, MD; Hye-Jeong Lee, MD; Jong-Won Ha, MD; Ji Hoe Heo, MD; Eui-Young Choi, MD; Chi-Young Shim, MD; Tae Hoon Kim, MD; Ji Eun Nam, MD; Kyu Ok Choe, MD Byoung Wook Choi, MD

From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Correspondence to Byoung Wook Choi, MD, PhD, Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul 120-752, South Korea. E-mail bchoi{at}yuhs.ac

Background and Purpose— 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.

Key Words: cardiac computed tomographic angiography • embolism • stroke • transesophageal echocardiography

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