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Utility of four-dimensional computed tomography angiography for evaluating the mobility of a thrombus in the ascending aorta.

ABSTRACT: Four-dimensional computed tomography has been used to evaluate moving structures and is a useful method to diagnose cardiovascular diseases. We report a case of cerebral infarction due to the thrombus in the ascending aorta, and utilized 4-dimensional computed tomography angiography for visualizing the movement of the thrombus, which prompted early surgical intervention to prevent further thromboembolism. Although transesophageal echocardiography is an established method to evaluate the ascending aorta, it has some contraindications and complications. Four-dimensional computed tomography angiography is an excellent alternative without blind spots to evaluate the ascending aorta more quickly than transesophageal echocardiography.

SUBMITTER: Asahara D

PROVIDER: S-EPMC6957809 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Utility of four-dimensional computed tomography angiography for evaluating the mobility of a thrombus in the ascending aorta.

Asahara Daisuke D Kuno Toshiki T Koizumi Kiyoshi K Itoh Takahito T Numasawa Yohei Y Kodaira Masaki M Isozumi Kazuo K Komatsumoto Satoru S

Radiology case reports 20200109 3

Four-dimensional computed tomography has been used to evaluate moving structures and is a useful method to diagnose cardiovascular diseases. We report a case of cerebral infarction due to the thrombus in the ascending aorta, and utilized 4-dimensional computed tomography angiography for visualizing the movement of the thrombus, which prompted early surgical intervention to prevent further thromboembolism. Although transesophageal echocardiography is an established method to evaluate the ascendin ...[more]

PMID: 31956381

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Project description:OBJECTIVE:To compare assessment of collaterals by single-phase computed tomography (CT) angiography (CTA) and CT perfusion-derived 3-phase CTA, multiphase CTA and temporal maximum-intensity projection (tMIP) images to digital subtraction angiography (DSA), and relate collateral assessments to clinical outcome in patients with acute ischemic stroke. METHODS:Consecutive acute ischemic stroke patients who underwent CT perfusion, CTA, and DSA before thrombectomy with occlusion of the internal carotid artery, the M1 or the M2 segments were included. Two observers assessed all CT images and one separate observer assessed DSA (reference standard) with static and dynamic (modified American Society of Interventional and Therapeutic Neuroradiology) collateral grading methods. Interobserver agreement and concordance were quantified with Cohen-weighted ? and concordance correlation coefficient, respectively. Imaging assessments were related to clinical outcome (modified Rankin Scale, ? 2). RESULTS:Interobserver agreement (n = 101) was 0.46 (tMIP), 0.58 (3-phase CTA), 0.67 (multiphase CTA), and 0.69 (single-phase CTA) for static assessments and 0.52 (3-phase CTA) and 0.54 (multiphase CTA) for dynamic assessments. Concordance correlation coefficient (n = 80) was 0.08 (3-phase CTA), 0.09 (single-phase CTA), and 0.23 (multiphase CTA) for static assessments and 0.10 (3-phase CTA) and 0.27 (multiphase CTA) for dynamic assessments. Higher static collateral scores on multiphase CTA (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7) and tMIP images (OR, 2.0; 95% CI, 1.1-3.4) were associated with modified Rankin Scale of 2 or less as were higher modified American Society of Interventional and Therapeutic Neuroradiology scores on 3-phase CTA (OR, 1.5; 95% CI, 1.1-2.2) and multiphase CTA (OR, 1.7; 95% CI, 1.1-2.6). CONCLUSIONS:Concordance between assessments on CT and DSA was poor. Collateral status evaluated on 3-phase CTA and multiphase CTA, but not on DSA, was associated with clinical outcome.

Dataset Information

Utility of four-dimensional computed tomography angiography for evaluating the mobility of a thrombus in the ascending aorta.

Publications

Utility of four-dimensional computed tomography angiography for evaluating the mobility of a thrombus in the ascending aorta.

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