CT左心耳充盈缺损:与MR增强及经食管超声心动图对比研究  

The study of left atrial appendage filling defect in CT:compared to MR enhancement and trans-esophageal echocardiogram

作　　者：侯居攀[1] 吕璐璐[1] 胡春艾[1] 孙卫红[1] 窦丽娜[1] 马爱丽 李光超[1] HOU Jupan;Lv Lulu;HU Chun 'ai;SUN Weihong;DOU Lina;MA Aili;LI Guangchao(CT/MR Room,the Central Hospital of Xuzhou,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院CT/MR室,江苏徐州221009

出　　处：《实用放射学杂志》2019年第1期44-47,共4页Journal of Practical Radiology

基　　金：徐州市中心医院院级课题(XZS201606);徐州市科技局备选项目(KC15SH092).

摘　　要：目的 探讨冠状动脉CTA左心耳充盈缺损形态与血栓的相关性;研究磁共振增强(MRE)对左心耳血栓的诊断效能。 方法 选取2014年1月至2017年1月行冠状动脉CTA检查出现左心耳充盈缺损,并行MRE及经食管超声心动图(TEE)检查的患者32例,以TEE为金标准,分析左心耳充盈缺损形态与血栓的相关性,并探讨MRE对左心耳血栓的诊断效能。 结果 将冠状动脉CTA充盈缺损的形态分3种:附壁形、圆形或类圆形、类三角形。附壁形3例,圆形或椭圆形4例,MRE及TEE均诊断左心耳血栓。三角形或类三角形25例,MRE血栓3例,阴性22例;TEE血栓4例,阴性16例,自发性回声5例。MRE诊断左心耳血栓的敏感度为90%,特异度为100%,阳性预测值为100%,阴性预测值为95%。MRE与TEE检查的诊断符合率为96%,两者对左心耳血栓的诊断一致性很好(k=0.790,P=0.000)。 结论 冠状动脉CTA扫描左心耳类三角形充盈缺损不是血栓的特征性征象,MRE可作为左心耳血栓评估的重要补充方法,具有高度的敏感性及特异性。Objective To evaluate the correlation between the morphology of left atrial appendage (LAA)filling defect during coronary CTA and thrombus,and to discuss the value of magnetic resonance enhancement (MRE)in the diagnosis of LAA thrombus.Methods A total of 32 patients detected LAA filling defect on coronary CTA scan from January 2014 to January 2017 were included.MRE and trans-esophageal echocardiogram (TEE)were performed respectively.The correlation between the morphology of LAA filling defect and thrombus were analyzed compared with TEE which was as the golden standard,the diagnostic efficacy of MRE in LAA thrombus was evaluated in the meantime with TEE.Results The morphology of filling defect was classified into three types:wall-attached,circular or quasi-circular,triangular.3 cases of wall-attached and 4 cases of circular or quasi-circular were all diagnosed LAA thrombus on both MRE and TEE.Among the 25 cases of triangular,3 cases were diagnosed LAA thrombus by MRE,while other 22 cases LAA thrombus negative,while 4 cases of thrombus by TEE,16 cases LAA thrombus negative,other 5 cases as spontaneous echo contrast (SEC).MRE had a sensitivity of 90%,specificity of 100%,positive predictive value of 100%and negative predictive value of 95% in LAA thrombus diagnosis.The diagnostic concordance rate between MRE and TEE was 96%,which showed good consistency in LAA thrombus diagnosis (k =0.790,P =0.000).Conclusion The kind of triangular filling defect during coronary CTA scan is not the characteristic feature of thrombus.MRE could serve as an important complementary method of detecting LAA thrombus with high sensitivity and specificity.

关 键 词：左心耳血栓 磁共振增强 经食管超声心动图 计算机体层成像 

分 类 号：R543.3[医药卫生—心血管疾病] R445.2[医药卫生—内科学]