Application of spectral computed tomography dual-substance separation technology for diagnosing left ventricular thrombus

Zeng, Hong; Zhang, Mengchao; He, Yan; Liu, Lin; Tong, Yaliang; Yang, Ping

doi:10.1177/0300060515600186

Cited by 10 publications

(7 citation statements)

References 22 publications

(33 reference statements)

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“…CT characteristics of LVT include lower attenuation with a threshold of 65 Hounsfield units, providing a sensitivity and specificity of 94% and 97%, respectively (16). It has been suggested that spectral CT dual-substance separation imaging and derived images of iodine-and blood-based densities are a feasible semiquantitative method to investigate LVT (20).…”

Section: Diagnosismentioning

confidence: 99%

Management of left ventricular thrombus: a narrative review

2021

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Left ventricular thrombus (LVT) is a serious complication of acute myocardial infarction (MI) and also non-ischemic cardiomyopathies. We performed a narrative literature review, manual-search of reference lists of included articles and relevant reviews. Our literature review indicates that the incidence of LVT following acute MI has decreased, probably due to improvement in patient care as a result of better and earlier reperfusion techniques. Predictors of LVT include anterior MI, involvement of left ventricular (LV) apex (regardless of the coronary territory affected), LV akinesis or dyskinesis, reduced LV ejection fraction (LVEF), severe diastolic dysfunction and large infarct size. LVT is associated with increased risk of systemic embolism, stroke, cardiovascular events and death, and there is evidence that anticoagulant therapy for at least 3 months can reduce the risk of these events. Cardiac magnetic resonance (CMR) has the highest diagnostic accuracy for LVT, followed by echocardiography with the use of echocardiographic contrast agents (ECAs). Although current guidelines suggest use of vitamin K antagonist (VKA) for a minimum of 3 to 6 months, there is growing evidence of the benefits of direct acting oral anticoagulants in treatment of LVT. Embolic events appear to occur even after resolution of LVT suggesting that anticoagulant therapy needs to be considered for a longer period in some cases. Recommendations for the use of triple therapy in the presence of the LVT are mostly based on extrapolation from outcome data in patients with atrial fibrillation (AF) and MI. We conclude that the presence of LVT is more likely in patients with anterior STsegment elevation MI (STEMI) (involving the apex) and reduced ejection fraction (EF). LVT should be considered a marker of increased long-term thrombotic risk that may persist even after thrombus resolution.Ongoing clinical trials are expected to elucidate the best management strategies for patients with LVT.

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Section: Diagnosismentioning

confidence: 99%

Management of left ventricular thrombus: a narrative review

2021

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“…5 Spectral CT technology has proved to be valuable in applications such as coronary artery imaging, 6 plaque detection, 7 and myocardial perfusion imaging, 8 but it has rarely been used to diagnose cardiac thrombi. 9 In this study, we explored the applicability and potential clinical use of cardiac spectral CT imaging to differentiate LAA thrombi from LAA pectinate muscles. We based our analysis on the spectral differentiation of iodine and blood and the derived iodine-and blood-based material decomposition images.…”

Section: Dual-energy Computed Tomography-enabled Materials Separation mentioning

confidence: 99%

Dual-Energy Computed Tomography-Enabled Material Separation in Diagnosing Left Atrial Appendage Thrombus

He¹,

Lin²,

Zhang³

et al. 2019

Texas Heart Institute Journal

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We explored the potential clinical value of material separation enabled by dual-energy spectral computed tomography in detecting left atrial appendage thrombi.The study enrolled 24 patients who were scheduled to undergo atrial fibrillation ablation (12 with and 12 without left atrial appendage thrombi). Computed tomograms were acquired in gemstone spectral imaging mode; the densities in the regions of the left atrial appendage cavities, pectinate muscles, and left atrial appendage thrombi were analyzed on monochromatic 70-keV images. Iodine and blood were chosen as the material basis pair; the iodine and blood densities were observed and quantitatively determined from the iodine-and blood-specific material decomposition images.On the 70-keV monochromatic and iodine-specific images, the left atrial appendage pectinate muscles and thrombi appeared as areas of hypodense attenuation. On the blood-specific images, similar areas of high attenuation were observed in the thrombi and cavities, whereas lower attenuation was noticed in the pectinate muscles. The quantitative iodine and blood densities in the pectinate muscles were lower than those in the cavities (P <0.001). The iodine densities in the thrombi were lower than those in the cavities (P <0.001); however, blood densities did not differ significantly between the thrombi and cavities (P=0.192). Compared with the pectinate muscles, the thrombi showed lower blood-density differences (P=0.003) and higher iodine-density differences (P=0.006) in relation to the cavities.Spectral computed tomography-enabled material separation is a novel method for differentiating left atrial appendage thrombi from pectinate muscles. The potential applications of this technology warrant further studies. (Tex Heart Inst J 2019;46(2):107-14) L eft atrial appendage (LAA) thrombus formation is one of the most frequent complications that develop in patients with atrial fibrillation (AF). Because LAA thrombi are often accompanied by peripheral arterial thromboembolic events such as ischemic stroke, they are associated with high morbidity and mortality rates. 1 To date, transesophageal echocardiography (TEE) is the chief method for diagnosing LAA thrombi. 2 However, in addition to its relatively invasive nature, TEE yields results that depend greatly on the operator's skill and experience. Occasionally, LAA pectinate muscles and spontaneous echocardiographic contrast (SEC) are misidentified as LAA thrombi on TEE. 2 Cardiac computed tomography (CT) has been validated as an alternative method for identifying LAA thrombi; however, traditional multislice spiral CT is prone to false-positive findings when used to detect LAA thrombi. 3,4 A novel technology has recently been introduced in the form of dual-energy spectral CT, which uses a single X-ray tube and enables fast tube-voltage switching between low and high kilovoltage to simultaneously collect low-and high-energy data. In addition to yielding 101 monochromatic images, spectral CT can generate materialspecific images based on the densities o...

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“…Specifically, virtual low-keV monoenergetic and iodine density images have been shown to improve contrast between iodine and soft tissue, and contrast-to-noise ratio 7 , 8 . Z-effective (zeff) images can be used to differentiate between tissue components by displaying effective atomic numbers 9 .The method can enhance contrast between iodinated contrast agent, left atrial and ventricular walls, and clots 10 – 12 , and thus aid in the detection of intra-cardiac thrombi.…”

Section: Introductionmentioning

confidence: 99%

Spectral cardiac CT in acute stroke patients

Larsen

Austein

Klintz

et al. 2023

Sci Rep

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Cardiac CT obtained in acute ischemic stroke patients can facilitate timely detection of cardiac sources of embolism and guide secondary prevention strategies. Spectral CT exploiting the simultaneous acquisition of separate higher-energy and lower-energy photon spectrum datasets has the potential to improve contrast between thrombi and cardiac structures. This study aimed to investigate the diagnostic value of spectral cardiac CT compared to conventional CT for the detection of cardiac thrombi in acute stroke patients. Patients with acute ischemic stroke undergoing spectral cardiac CT were retrospectively included. Conventional CT images, virtual 55 keV monoenergetic (monoE55), z-effective (zeff), and iodine density images were evaluated for the presence of thrombi. Diagnostic certainty was rated on a 5-point Likert scale. Contrast ratios were calculated for all reconstructions. 63 patients with 20 thrombi were included. Four thrombi were missed on conventional images but detected on spectral reconstructions. MonoE55 achieved the highest scores for diagnostic certainty. Contrast ratios were highest on iodine density images, followed by monoE55, conventional and zeff (p < 0.005). Spectral cardiac CT adds diagnostic benefit for the detection of intra-cardiac thrombi in acute ischemic stroke patients compared to conventional CT.

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Application of spectral computed tomography dual-substance separation technology for diagnosing left ventricular thrombus

Cited by 10 publications

References 22 publications

Management of left ventricular thrombus: a narrative review

Management of left ventricular thrombus: a narrative review

Dual-Energy Computed Tomography-Enabled Material Separation in Diagnosing Left Atrial Appendage Thrombus

Spectral cardiac CT in acute stroke patients

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