학술논문
Prevalence of major embolic findings and incidental findings on early cardiac CT in patients with suspected ischemic stroke.
Document Type
Academic Journal
Author
Philippe D; Department of Radiology, University Hospital, 21709 Dijon, France.; Bernard A; Department of Radiology, University Hospital, 21709 Dijon, France.; Ricolfi F; Department of Radiology, University Hospital, 21709 Dijon, France.; Béjot Y; PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France.; Duloquin G; PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France.; Comby PO; Department of Radiology, University Hospital, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France.; Guenancia C; PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Cardiology, University Hospital, 21709 Dijon, France. Electronic address: charles.guenancia@chu-dijon.fr.
Source
Publisher: Elsevier Masson Country of Publication: France NLM ID: 101568499 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2211-5684 (Electronic) Linking ISSN: 22115684 NLM ISO Abbreviation: Diagn Interv Imaging Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: The purpose of this study was to assess the type and prevalence of stroke and non-stroke-related findings diagnosed on early cardiac computed tomography (CT) in patients with suspected stroke. The secondary objective was to assess the clinical consequences on the management of patients with non-stroke-related conditions identified by early cardiac CT.
Materials and Methods: This single-center, retrospective, observational study included 1111 consecutive patients with suspected ischemic stroke between November 2018 and March 2020 who underwent cardiac CT examination in addition to the usual brain CT protocol (i.e., non-enhanced brain CT, perfusion brain CT when needed, aortic arch and supra-aortic CT angiography, and post contrast brain CT). There were 562 women and 549 men with a median age of 74 years (range: 60-85 years). Of these, 415 (415/1111; 37.4%) patients had ischemic stroke and 692 (692/1111; 62.3%) had no stroke. Cardiac CT examinations were retrospectively reviewed for cardiac CT findings at high embolic risk and clinically significant extracardiac incidental findings.
Results: Among 1111 included patients, 89 (89/1111; 8.0%) had a stroke-related condition identified on early cardiac CT. This was significantly more frequent in patients with ischemic stroke (66/415; 15.9%) by comparison with those without ischemic stroke (23/696; 3.3%) (P < 0.001), with 41 patients (41/415; 9.9%) diagnosed with left atrial thrombus. Cardiac CT revealed a clinically significant non-stroke-related finding in 173 patients (173/1111; 15.6%), including 17 pulmonary embolisms (1.5%), seven suspicious pulmonary lesions (0.6%), and three breast lesions suspected to be malignant (0.3%). Twenty out of 173 patients (20/173; 11.5%) with incidental findings on early cardiac CT had a change in their management.
Conclusion: This study shows that adding early cardiac CT to brain CT during the acute phase of an ischemic stroke leads to a higher rate of etiological diagnoses and highlights the major interest of looking at the bigger picture.
Competing Interests: Declaration of competing interest The authors declare no actual or potential conflict of interest related to this study.
(Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
Materials and Methods: This single-center, retrospective, observational study included 1111 consecutive patients with suspected ischemic stroke between November 2018 and March 2020 who underwent cardiac CT examination in addition to the usual brain CT protocol (i.e., non-enhanced brain CT, perfusion brain CT when needed, aortic arch and supra-aortic CT angiography, and post contrast brain CT). There were 562 women and 549 men with a median age of 74 years (range: 60-85 years). Of these, 415 (415/1111; 37.4%) patients had ischemic stroke and 692 (692/1111; 62.3%) had no stroke. Cardiac CT examinations were retrospectively reviewed for cardiac CT findings at high embolic risk and clinically significant extracardiac incidental findings.
Results: Among 1111 included patients, 89 (89/1111; 8.0%) had a stroke-related condition identified on early cardiac CT. This was significantly more frequent in patients with ischemic stroke (66/415; 15.9%) by comparison with those without ischemic stroke (23/696; 3.3%) (P < 0.001), with 41 patients (41/415; 9.9%) diagnosed with left atrial thrombus. Cardiac CT revealed a clinically significant non-stroke-related finding in 173 patients (173/1111; 15.6%), including 17 pulmonary embolisms (1.5%), seven suspicious pulmonary lesions (0.6%), and three breast lesions suspected to be malignant (0.3%). Twenty out of 173 patients (20/173; 11.5%) with incidental findings on early cardiac CT had a change in their management.
Conclusion: This study shows that adding early cardiac CT to brain CT during the acute phase of an ischemic stroke leads to a higher rate of etiological diagnoses and highlights the major interest of looking at the bigger picture.
Competing Interests: Declaration of competing interest The authors declare no actual or potential conflict of interest related to this study.
(Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)