Multidetector computed tomography (MDCT) angiography of thoracic aortic coarctation in pediatric patients: Pre-operative evaluation

Objective

The purpose of this study was to evaluate the reliability of 64-slice multi-detector computed tomographic (MDCT) angiography in pre-operative assessment of coarctation of thoracic aorta of pediatric age groups using 64 multislice CT scanner.

Materials and methods

Twenty four patients with clinical suspicion of coarctation of the thoracic aortic anomalies who underwent both Doppler echocardiography and MDCT angiography were included in the study. MDCT angiography findings were compared with both Doppler echocardiography and surgical results.

Results

The overall sensitivity of the MDCT angiography for diagnosis of the extra-cardiac aortic anomalies was 100% which was higher than that of Doppler echocardiography (92%). The overall sensitivity of MDCT angiography for the assessment of cardiac defects was 85% which was lower than that of Doppler echocardiography (100%).

Conclusion

We concluded that MDCT angiography with multiplanar and three dimensional techniques can be considered the modality of choice for pre-operative assessment of coarctation of the thoracic aorta in pediatric patients.     

MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults: comparison of axial, multiplanar, and 3D images

OBJECTIVE: The objective of our study was to compare accuracies of axial, multiplanar, and 3D volume-rendered images in the diagnosis of thoracic aortic anomalies in pediatric patients and young adults. MATERIALS AND METHODS: Fourteen patients, 17 days to 20 years old, with thoracic aortic anomalies underwent MDCT using axial, multiplanar, and 3D volume-rendering imaging. All images were reviewed by three radiologists for position of the aortic arch, coarctation, vascular compression of the airway, collateral vessel formation, and aortopulmonary shunts (patent ductus arteriosus). Final diagnosis was determined by echocardiography, conventional angiography, bronchoscopy, or surgery. Diagnostic accuracy, sensitivity, and interobserver agreement were evaluated. RESULTS: Average accuracies (average of the three observers for a correct diagnosis) were greater than or equal to 96% for diagnoses of aortic position and airway narrowing on all image types. For the diagnosis of coarctation, average sensitivities (average of the three observers for a true diagnosis) were 73% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. For the diagnosis of patent ductus arteriosus, average sensitivities were 78% for axial, 94% for multiplanar, and 89% for 3D volume-rendered images. No patients in this study had collateral vessel formation. For the diagnosis of absence of collateral vessel formation, average sensitivities were 100% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. There were no significant statistical differences in diagnostic performances, agreement with truth, or confidence scores among observers or imaging formats (p > 0.05). CONCLUSION: Axial, multiplanar, and 3D volume-rendered images serve equally well as methods for assessing the side of the aorta to diagnose anomalies. For evaluation of coarctation and patent ductus arteriosus, multiplanar and 3D volume-rendered images perform slightly better than axial images.     

Role of 320-MDCT in assessment of cardiac great arteries anomalies

Objectives

To assess the role of 320 MDCT angiography in the evaluation of extra cardiac, vascular anomalies of great arteries and compare its results with transthoracic echocardiography and its impact on treatment planning.

Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age

BackgroundAim of this study was to assess the accuracy of ventricular septal defects (VSD) using high pitch computed tomography angiography (CTA) of the chest in children below 1 year of age, compared to the intraoperative findings and echocardiography.MethodsOut of 154 patients that underwent Dual-Source CTA of the chest using a high-pitch protocol at low tube voltages (70–80 kV), 55 underwent surgical repair of a VSD (median age 8 days, range 1–348 days). The margins of the VSDs and their relation to the surrounding structures were reproduced by en-face views using multiplanar reformations (MPR). Absolute diameter, normalized area and relative area compared to the aortic valve annulus were used for discrimination between restrictive and non-restrictive defects. Localization was classified into four subtypes. The results were compared to two-dimensional echocardiography and intraoperative findings.ResultsMedian absolute size of VSDs did not differ significantly between CTA-measurements (10.8 mm, range 2.8–18.1 mm) and intraoperative findings (12.0 mm, 3.0–25.0 mm, p = 0.09). Echocardiographic values were significantly lower (9.6 mm, 3.0–18.5 mm, both p < 0.01). The classification of the location and orientation matched the intraoperative situs in 96.4% of all cases using CT and in 87.3% using echocardiography. Echocardiography missed the relation to valves in 11% of all cases. Pre-interventional sensitivity and specificity for detection of a VSD were 97.2/98.9% compared to echocardiography. Median radiation dose was 0.32 mSv (range 0.12–2.00 mSv) and differed significantly between second and third generation Dual-Source CT (0.43 vs. 0.22 mSv, p = 0.003).ConclusionSize and subtype of VSDs can be accurately assessed by CTA of the chest in patients with complex congenital heart defects at a very low radiation dose.     

先天性主动脉缩窄的影像学检查:应用与评价

目的：评价心脏超声(TTE)、心血管造影(CAG)、电子束CT(EBCT)和MRI在诊断主动脉缩窄中的作用。方法：主动脉缩窄患者16例，单纯型2例，复杂型14例；14例行手术治疗。全部病例均行TTE和彩色多普勒血流显像检查，14例行CAG检查，3例行MRI检查，1例行EBCT检查。结果：TTE的诊断准确率为42．9％(6／14)，CAG的诊断准确率为100％(12／12)，EBCT(1例)和MRI(3例)均获得正确诊断。结论：在诊断主动脉缩窄上，CAG、EBCT和MRI明显优于TTE；EBCT和MRI是显示主动脉缩窄的无创伤性检查方法，MRI无需对比剂即可多平面直接显示病变部位及合并畸形等病变全貌，且无辐射，优于EBCT。MRI可以作为诊断主动脉缩窄首选的检查方法。     

Correlation of 64 row MDCT,echocardiography and cardiac catheterization angiography in assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease

Objective

To study the correlation of low-dose 64-row multi-detector computed tomography (MDCT) with echocardiography and cardiac catheterization angiography (CCA) in the assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease (CCHD).

Materials and methods

This prospective study included 105 children (74 males, 31 females) with CCHD, in the age group of 2 months to 20 years, who underwent 64-row MDCT examination (low-dose CT protocol), echocardiography and CCA for the assessment of pulmonary arteries, including visualization, presence of confluence, stenosis and collaterals. Statistical analysis was performed using the non-parametric statistical analysis test to evaluate the concordance or discordance between echocardiography, MDCT and CCA.

Results

64-row MDCT detected significantly more main and branch pulmonary arteries, patent pulmonary confluences, and more cases of pulmonary artery stenosis. CCA detected more major aorto-pulmonary collaterals than MDCT, whereas echocardiography failed to identify these major aorto-pulmonary collaterals. The effective CT radiation dose to patients less than 2 years of age was in the range of 0.7–2.5 mSv, where as the dose in patients more than 2 years of age ranged from that of 2.1 to 4.2 mSv, which is much less than the radiation dose reported in cardiac catheterization angiography.

Conclusion

In cases where cardiac MRI cannot be performed, or is not sufficiently informative, low-dose 64-row MDCT correlates well with CCA and can provide adequate information about pulmonary arterial anatomy in children with cyanotic congenital heart disease, and can replace invasive cardiac catheterization angiography with markedly reduced radiation dosage to the patient.     

Value of MDCT as a non- invasive modality in evaluation of pediatric congenital cardiovascular anomalies

Objective

Assessing the role of MSCT compared to TTE in pediatric patients with congenital heart diseases especially the thoracic congenital vascular anomalies.

Role of multi-slice CT angiography in the evaluation of pulmonary venous anomalies

Purpose and aim

To assess the role of MSCT angiography in evaluation of extra-cardiac vascular abnormalities in pulmonary venous anomalies and compare it with echocardiography.

Materials and methods

This study included 26 patients with an age range of 15 days–25 years. All of these patients underwent MSCT angiography and echocardiography. Only 10 patients underwent cardiac catheterization.

Results

Our initial experience showed that MSCT is capable of complementing echocardiography and replacing diagnostic cardiac catheterization for anatomical delineation if performed with an optimum technique.MSCT angiography proved to be a worthy primary investigation tool in patients whom ECHO has been able to clearly identify the intracardiac anatomy, but not the extra-cardiac vascular anatomy.

Conclusion

MDCT correctly depicted the TAPVR (Total anomalous pulmonary venous return) and PAPVR (Partial anomalous pulmonary venous return) types of pulmonary venous anomalies with sensitivity 100%, and specificity 100%. The specificity of echocardiography was 50% for both findings. Inspite of the risk of ionizing radiation and contrast medium injection the adoption of our minimal invasive, low radiation, non-ECG gated protocol greatly reduces the time, radiation dose, and contrast medium volume needed to perform an optimum CT angiographic technique. Thus, paving a clear road map for pre and post operative assessment of patients with pulmonary venous anomalies.     

彩色多普勒超声心动图诊断主动脉缩窄

目的:探讨多普勒超声心动图对主动脉缩窄的诊断价值。方法:回顾性分析10例主动脉缩窄患者多普勒超声心动图检查结果与手术所见。结果:10例患者术前超声心动图检查诊断正确8例,漏诊2例(其中升主动脉管性缩窄1例,主动脉嵴部缩窄1例)。结论:彩色多普勒超声心动图能准确显示主动脉缩窄部位;动脉导管未闭(PDA)患者应常规探查主动脉弓及降主动脉。     

Radiological evaluation of post-traumatic tracheal stenosis using multidetector CT with multiplanar reformatted imaging and virtual bronchoscopy: Comparison with intraoperative findings

Aim

To evaluate the diagnostic utility of multidetector computed tomography (MDCT) (axial, multiplanar reformatted images and virtual bronchoscopy) in preoperative assessment of post-traumatic tracheal stenosis.

Materials and methods

Twenty-four patients with post-traumatic tracheal stenosis underwent tracheal resection anastomosis. The diagnosis was ascertained on the basis of history and rigid-bronchoscopy. All patients were preoperatively evaluated by MDCT. Intraoperative findings were used as the gold standard. Lesions were evaluated in terms of site, distance from the vocal cords, length, grade of the stenosis and length of the planned resected segment.

Results

The sensitivity of MDCT was 100%, 100%, 92.3%, 92.3%, 96% and its accuracy was, 100%, 100%, 96%, 96%, 88.8% in assessment of tracheal stenotic site, distance from the vocal cords, length, length of segment planned for resection and stenotic grade, respectively. MPR (coronal and sagittal reformatted) images were 100% sensitive in detecting stenotic site and distance from the vocal cord. It showed 92.3% sensitivity and 96% accuracy in assessment of the stenotic segment length and the length of segment planned for resection. VB showed 96% sensitivity and 88.8% accuracy.

Conclusion

MDCT with its various display modes improved the preoperative evaluation of post-traumatic tracheal stenosis. The combined interpretation of axial, multiplanar reformatted and VE leads to improved diagnostic confidence. We recommend it as a constant demand for preoperative evaluation of post-traumatic tracheal stenosis.     

iDose重建技术在先天性心脏病低剂量CT成像中的应用

目的 探讨迭代重建技术（iDose）在先天性心脏病低剂量CT成像中的应用价值。 方法 将88例临床诊断为先天性心脏病或者先天性心脏病术后的患儿用随机数字表法分成4组,进行以体重为基础的常规X射线剂量（A组）及降低X射线剂量（B组：降低30%;C组：降低50%;D组：降低70%）前瞻性心电触发轴扫模式CT血管造影（CTA）检查,所有数据均分别采用滤波反投影（FBP）、iDose2级、iDose4级、iDose6级重建,测量升主动脉根部及肺动脉主干噪声,对图像质量进行评分,并对4组结果进行比较。 结果 A、B、C、D 4组内iDose6级重建组图像噪声最低,FBP重建组图像噪声最高,且iDose6级重建组与其余3个重建组图像噪声的差异有统计学意义（P<0.05）。用iDose6级重建后D组病例的主观评分均在3分或以上,D组用iDose6级处理后的图像主观评分与A组用FBP处理后的相当。D组患者的有效辐射剂量为（0.65±0.43）mSv。 结论 应用iDose迭代重建技术可降低噪声,提高图像质量,其中用iDose6级处理在同等条件下效果最好。在先天性心脏病CT成像中,用iDose6级重建可以降低70%的辐射剂量进行扫描。     

Role of color Doppler ultrasonography and multidetector computed tomography angiography in diagnosis of uterine arteriovenous malformations

Aim of work

To assess the role of color Doppler ultrasonography and multidetector computed tomography angiography (MDCTA) in diagnosis of uterine arteriovenous malformations (AVMs).

Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries

Purpose

Our aim was to evaluate the accuracy, sensitivity and specificity of 64-slice multidetector computed tomography (MDCT) in the assessment of occlusions and stenoses of arterial and venous bypass grafts and disease progression in the native vessels distal to the graft, and to compare the results with those of conventional coronary angiography.

Materials and methods

We enrolled 78 individuals (45 men, 33 women; mean age 59) and evaluated 213 bypass grafts using a 64-slice MDCT scanner. All patients underwent conventional coronary angiography with a mean time interval between the two examinations of 2 days.

Results

One patient was excluded due to arrhythmia during the examination. The 212 bypass grafts in the remaining 77 patients (98.7%) consisted of 115 (54%) venous grafts and 97 (46%) arterial grafts. In the 115 venous grafts, MDCT showed a sensitivity, specificity and accuracy of 100% in evaluating occluded grafts and a sensitivity of 94.4%, specificity of 98.4% and accuracy of 96.9% in evaluating significant stenoses. In evaluating occluded arterial grafts, sensitivity was 83.3%, specificity 100% and accuracy 98.9%, whereas in evaluating stenoses of arterial grafts, sensitivity was 100%, specificity 97.7% and accuracy 98%.

Conclusions

Sensitivity, specificity and accuracy in evaluating native coronary vessels distal to the graft allow for a complete assessment of the surgical and native circulation. The examination appears therefore to be exhaustive in ruling out or confirming the presence of diseased vessels in the postoperative follow-up.     

Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts

Purpose

The purpose of the study was to compare the diagnostic value of color Doppler ultrasonography (CDUS) and multidetector computed tomography (MDCT) angiography against that of digital subtraction angiography (DSA) or surgery in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs).

Materials and methods

CDUS and MDCT angiography were performed with 41 patients (24 men, 17 women; mean age 55.8) with dysfunctional hemodialysis fistulas. The presence of stenosis, thrombosis, aneurysm, pseudoaneurysm and seroma were recorded. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of CDUS and MDCT angiography were calculated both individually and in combination for the detection of vascular segments with significant stenosis, thrombosis, aneurysms, pseudoaneurysms, perivascular complications and stenosis subgroups.

Results

Sixty-four segmental lesions were diagnosed by DSA or surgery. Sensitivity, specificity, PPV, NPV and accuracy of CDUS for all vascular tree lesions were 85.9%, 99.2%, 96.4%, 96.7% and 94.5%, respectively. For MDCT angiography the figures were 96.8%, 99.6%, 98.4%, 99.2% and 98.5%, respectively. When both tests were used in combination, sensitivity, specificity, PPV, NPV and accuracy for all vascular tree lesions rose to 100%.

Conclusion

Combined use of MDCT and CDUS for diagnosis of AVF dysfunctions is of equivalent value to surgery or DSA, a gold standard technique.     

The value of 16-slice multidetector computed tomographic angiography in preoperative appraisal of vascular anatomy in potential living renal donors

Background

Comprehensive preoperative appraisal of potential living renal donors is the key for selecting a proper donor and a suitable kidney.

Objective

To prospectively assess the diagnostic value of 16-slice multidetector computed tomography (MDCT) in preoperative appraisal of vascular anatomy in potential living renal donors.

Materials and methods

Preoperative angiography using a 16-slice MDCT scanner was performed in 68 consecutive potential living renal donors. The MDCT angiography included unenhanced and contrast-enhanced multiphasic scans. The MDCT images were reviewed for the number and branching pattern of the renal arteries and for the number and presence of major or minor variants of the renal veins. The results were compared with the actual anatomy at the open donor nephrectomy as the diagnostic standard of reference.

Results

The sensitivity and the specificity of MDCT angiography for the detection of various anatomic variants of renal arteries as well as renal venous anomalies were 100%. The anatomic variants of renal arteries included accessory arteries (n = 7) and early arterial branching (n = 10). Whereas, the detected venous anomalies were of major category of the circumaortic left renal vein anomaly (n = 2). No minor renal venous anomaly was identified in any subject.

Conclusion

16-Slice MDCT angiography is highly accurate for preoperative assessment of diverse anomalies of the renal vascular anatomy in potential living renal donors; in consequence, it markedly affects the surgical planning.     

Aortic annulus and ascending aorta: Comparison of preoperative and periooperative measurement in patients with aortic stenosis

Background

Precise determination of the aortic annulus size constitutes an integral part of the preoperative evaluation prior to aortic valve replacement. It enables the estimation of the size of prosthesis to be implanted. Knowledge of the size of the ascending aorta is required in the preoperative analysis and monitoring of its dilation enables the precise timing of the operation. Our goal was to compare the precision of measurement of the aortic annulus and ascending aorta using magnetic resonance (MR), multidetector-row computed tomography (MDCT), transthoracic echocardiography (TTE), and transoesophageal echocardiography (TEE) in patients with degenerative aortic stenosis.

Methods and results

A total of 15 patients scheduled to have aortic valve replacement were enrolled into this prospective study. TTE was performed in all patients and was supplemented with TEE, CT and MR in the majority of patients. The values obtained were compared with perioperative measurements. For the measurement of aortic annulus, MR was found to be the most precise technique, followed by MDCT, TTE, and TEE. For the measurement of ascending aorta, MR again was found to be the most precise technique, followed by MDCT, TEE, and TTE.

Conclusion

In our study, magnetic resonance was found to be the most precise technique for the measurement of aortic annulus and ascending aorta in patients with severe degenerative aortic stenosis.     

Multidetector-row CT angiography for preoperative evaluation of potential laparoscopic renal donors: how accurate are we?

The purpose of this study was to evaluate multidetector-row computed tomography (MDCT) angiography in preoperative evaluation of renal donors for renal vascular abnormalities. Eighty-one patients underwent renal MDCT angiography and laparoscopic donor nephrectomy. MDCT angiographic findings were compared with surgical findings. The sensitivity and specificity of MDCT angiography for detection of accessory arteries, prehilar renal artery branching, and renal venous anomalies were 88% and 98%, 100% and 97%, and 100% and 97%, respectively. CT findings agreed with surgical findings for accessory renal arteries, prehilar renal artery branching, and renal venous anomalies in 94%, 93%, and 98% of patients, respectively.     

Multidetector–row CT angiography of renal artery stenosis in 50 consecutive patients: prospective interobserver comparison with DSA

PURPOSE: The purpose of this study was to establish the diagnostic value of multidetector-row computed tomography (MDCT) angiography compared with digital subtraction angiography (DSA) for detection and quantification of both main and accessory renal artery stenosis in patients with secondary hypertension. MATERIALS AND METHODS: Fifty consecutive patients scheduled for DSA were considered candidates for MDCT angiography. In all patients, MDCT angiography of the abdominal aorta was performed before DSA. For the purpose of interpretation, the arteries were separately interpreted either with DSA or MDCT angiography in order to provide qualitative and quantitative information. For qualitative evaluation, one experienced reader graded the opacification of renal arteries as excellent, good or poor; for quantitative evaluation, MDCT and DSA were independently evaluated for the number of renal arteries and the presence, location and degree of stenosis in random order by three readers. On the basis of consensus readings, calculations of sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for detection of degree of stenosis were made by using DSA findings as the standard of reference. Interobserver variability was also assessed. RESULTS: With regard to qualitative analysis, arterial enhancement was considered excellent in 39 patients and good in 11. For quantitative analysis, 73 arteries were classified as normal with DSA. Although 72 of these were also classified as normal with CT angiography, one was overestimated by one grade; at DSA, 16 arteries were classified as moderately stenotic; in two arteries, there was an overestimation of one grade. Perfect correlation was achieved for the diagnosis of occlusion. In two patients, all three readers detected multiple severe stenoses on both modalities, with a "string-of-beads" appearance typical of fibromuscular dysplasia. Accessory arteries were correctly identified as such by all three readers on either DSA or MDCT. Levels of sensitivity, specificity and accuracy regarding degree of stenosis were 100%, 98.6% and 96.9%, respectively, with PPV and NPV of 97.6% and 100%, respectively. When we considered significant arterial stenosis (50%-100% luminal narrowing), sensitivity, specificity and accuracy were 100%, 97.3% and 97.8%, respectively, with a PPV and NPV of 98.2% and 97.8%, respectively. For all observers, interobserver agreement was almost perfect (k=0.81-1) for both MDCT and DSA, with a k value between 0.82 and 0.95. CONCLUSIONS: MDCT angiography is very accurate and robust, even for the assessment of renal artery stenosis, and has the potential to become a viable substitute, in most cases, for diagnostic catheter-based DSA.     

Evidence based medicine: role of multidetector CT in the follow-up of patients receiving coronary artery bypass graft

PURPOSE: The aim of this study was to define the role of multidetector computed tomography (MDCT) in the follow-up assessment of patients undergoing coronary artery bypass grafting (CABG) using an evidence-based medicine (EBM) approach. MATERIALS AND METHODS: We performed a literature search of the most reputable studies published in the period 1990-2005 on the clinical follow-up of patients after myocardial revascularisation by CABG. Relevant studies were ranked according to levels of evidence using EBM criteria. A similar search was also conducted on the Internet to identify and review the guidelines posted by the major international scientific societies. RESULTS: A total of 29 papers meeting the basic reliability requirements of EBM were identified. The reported sensitivity and specificity for electrocardiogram (ECG) testing, stress echocardiography and radionuclide myocardial perfusion imaging were 45% and 82%, 86% and 90%, and 68% and 84%, respectively. All 16 CT studies (one retrospective, the remaining prospective) were validation studies comparing MDCT with conventional coronary angiography. The total number of patients and graft segments studied were 705 and 1,974, respectively. The total number of assessable graft segments were 62%-100%, with a sensitivity and specificity of 75%-100% and 76.9%-100%, respectively. CONCLUSIONS: The applications of MDCT in the follow-up assessment of patients after CABG are derived from indirect evidence only. The efficacy of the method should be evaluated in randomised clinical trials comparing MDCT not only with conventional coronary angiography but also with other noninvasive stress imaging methods. On the basis of the clinical evidence reported in the literature, the indications for the use of MDCT are still limited. In our view, the completion of such randomised trials combined with the development of new-generation scanners is required to correctly define the role of MDCT in the follow-up assessment of patients who have undergone CABG.     

Multilevel Assessment of Atherosclerotic Extent Using a 40-Section Multidetector Scanner after Transient Ischemic Attack or Ischemic Stroke

BACKGROUND AND PURPOSE:The first part of this study assessed the potential of MDCT with a CTA examination of the aorta and the coronary, cervical, and intracranial vessels in the etiologic work-up of TIA or ischemic stroke compared with established imaging methods. The objective of the second part of this study was to assess the atherosclerotic extent by use of MDCT in these patients.MATERIALS AND METHODS:From August 2007 to August 2011, a total of 96 patients with ischemic stroke or TIA without an evident cardioembolic source were enrolled. All patients underwent MDCT. Atherosclerotic extent was classified in 0, 1, 2, 3, and 4 atherosclerotic levels according to the number of arterial territories (aortic arch, coronary, cervical, intracranial) affected by atherosclerosis defined as ≥50% cervical, intracranial, or coronary stenosis or ≥4-mm aortic arch plaque.RESULTS:There were 91 patients who had an interpretable MDCT. Mean age was 67.4 years (± 11 years), and 75 patients (83.3%) were men. The prevalence of 0, 1, 2, 3, and 4 atherosclerotic levels was 48.3%, 35.2%, 12.1%, 4.4%, and 0%, respectively. Aortic arch atheroma was found in 47.6% of patients with 1 atherosclerotic level. The combination of aortic arch atheroma and cervical stenosis was found in 63.6% of patients with ≥2 atherosclerotic levels. Patients with ≥2 atherosclerotic levels were older than patients with < 2 atherosclerotic levels (P = .04) in univariate analysis.CONCLUSIONS:MDCT might be useful to assess the extent of atherosclerosis. It could help to screen for high-risk patients who could benefit from a more aggressive preventive strategy.

Assessment of atherosclerosis from the heart to the brain in patients with stroke may allow an optimal selection of high-risk patients who could benefit from a more aggressive preventive strategy. Several studies have evaluated the accuracy of MDCT with CTA examination of the aorta and coronary, cervical, and intracranial vessels to detect atherosclerosis.^1–5The first part of our study was a single-center, prospective, open-pilot study that was designed to assess MDCT with a CTA examination of the aorta and coronary, cervical, and intracranial vessels in the etiologic work-up of TIA and acute ischemic stroke compared with established imaging methods. Clinical and radiologic methods have been described elsewhere.⁶ In brief, patients 28–90 years old who were admitted to the hospital for a recent TIA or acute ischemic stroke without evident cardioembolic source in the Lyon Stroke Unit between August 1, 2007, and April 30, 2008, were included in this study. The period of inclusion was later extended to August 1, 2011. All patients had an MDCT examination with CTA of the aorta and coronary, cervical, and intracranial vessels compared with transthoracic echocardiography and transesophageal echocardiography, duplex ultrasonography of the cervical vessels, and MRA of the cervical and intracranial vessels. MDCT was not a part of the initial acute stroke assessment but was done within 7 days. We obtained approval from our local ethics committee and institutional review board and informed consent from each patient. It has been demonstrated that MDCT is feasible and accurate for the identification of stroke causes though its sensitivity for the detection of minor cardiac sources is limited.The objective of the second part of our study was to assess the global atherosclerotic extent by using MDCT in these patients.