Feasibility and Diagnostic Yield of Left Atrial Appendage Imaging in Comprehensive CT Stroke Protocols

Background/Objectives: Cardioembolic sources account for a substantial minority of ischemic strokes, and in non-valvular atrial fibrillation nearly all left atrial thrombi form in the left atrial appendage (LAA). We asked whether extending a standard CT stroke protocol caudally to cover the LAA would add diagnostic yield for LAA thrombus.

Methods

We retrospectively reviewed 616 consecutive patients imaged using a revised CT stroke protocol at a single academic center between March 2018 and March 2020. The acquisition was single-phase, arterial and non-gated. Two cardiothoracic radiologists reassessed every study for adequacy of LAA opacification and for thrombus. Acute stroke was confirmed in 418 patients, of whom 342 had adequate opacification and formed the analysis cohort. Clinical characteristics, stroke etiology, echocardiographic results and dose-length product were abstracted.