Dual-helical CT for detecting aortic atheromas as a source of stroke: comparison with transesophageal echocardiography.

PURPOSE: To investigate whether unenhanced dual-helical computed tomography (CT) is useful in the rapid, noninvasive detection of protruding aortic atheromas.

MATERIALS AND 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.

CONCLUSION: 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.