Prevalence of major embolic findings and incidental findings on early cardiac CT in patients with suspected ischemic stroke

Diane Philippe; Angélique Bernard; Frédéric Ricolfi; Yannick Béjot; Gauthier Duloquin; Pierre-Olivier Comby; Charles Guenancia

doi:10.1016/j.diii.2024.02.012

Prevalence of major embolic findings and incidental findings on early cardiac CT in patients with suspected ischemic stroke

Diagn Interv Imaging. 2024 Mar 1:S2211-5684(24)00047-0. doi: 10.1016/j.diii.2024.02.012. Online ahead of print.

Authors

Diane Philippe¹, Angélique Bernard¹, Frédéric Ricolfi¹, Yannick Béjot², Gauthier Duloquin², Pierre-Olivier Comby³, Charles Guenancia⁴

Affiliations

¹ Department of Radiology, University Hospital, 21709 Dijon, France.
² PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France.
³ Department of Radiology, University Hospital, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France.
⁴ 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.

PMID: 38431431
DOI: 10.1016/j.diii.2024.02.012

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.

Keywords: Cardiac CT; Computed tomography angiography; Incidentaloma; Ischemic stroke; Thrombosis.