DUAL-HELICAL CT FOR DETECTING AORTIC ATHEROMAS AS A SOURCE OF STROKE - COMPARISON WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY

PURPOSE: To investigate whether unenhanced dual-helical computed tomog raphy (CT) is useful in the rapid, noninvasive detection of protruding aortic atheromas. MATERIALS AND METHODS: Thirty-two consecutive patie nts 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 protr uding aortic atheromas in 15 patients (47%); dual-helical CT depicted protruding aortic atheromas in 13 of those 15 patients (87%). Of the 1 7 patients without a protruding aortic atheroma at TEE, dual-helical C T helped confirm the absence in 14 (82%). Dual-helical CT yielded a se nsitivity of 87%, a specificity of 82%, and an overall accuracy of 84% . thirty-six protruding plaques were detected with TEE, of which 34 (9 4%) were correctly identified with dual-helical CT. Of those 34 plaque s, 27 (79%) contained variable amounts of calcium and seven (21%) show ed hypoattenuation suggestive of soft plaques and thrombi. In six pati ents, dual-helical CT depicted a protruding aortic atheroma between th e 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 b e useful for the rapid, noninvasive detection of a protruding aortic a theroma, especially in areas not clearly visualized with TEE.