64排螺旋CT与经食道超声对房颤患者左房血栓的检测  

Detection of thrombus in the left atrial by 64-slice CT compared to transesophageal echocardiography

作　　者：张丽丽[1] 石琳[1] 祝安慧 仲挥[3] 王玉凤[3] 王斌[1] 赵运涛[1] 张建强[1] 易忠[1] 

机构地区：[1]航天中心医院心脏中心,北京100049 [2]北京大学第三医院放射科,100191 [3]航天中心医院超声科,北京100049

出　　处：《中国心血管杂志》2016年第1期42-45,共4页Chinese Journal of Cardiovascular Medicine

基　　金：航天中心医院院级课题(2011004)~~

摘　　要：目的探讨64排螺旋CT(64SCT)扫描对房颤患者左房血栓的检测价值。方法选择2009年1月至2015年2月就诊于我院心脏诊疗中心拟行房颤射频消融术的房颤病例,行64SCT肺静脉检查及经食道超声心动图检查(TEE),并将64SCT与TEE检测左房或左心耳血栓的结果进行比较分析。结果共计入选资料完整的房颤患者89例,以TEE作为"金标准",其中75例64SCT扫描与TEE诊断相符,诊断符合率为84.27%(75/89)。64SCT检测左房或左心耳血栓的诊断特异度为98.48%(65/66),诊断灵敏度为43.48%(10/23),阳性预测值为90.91%(10/11),阴性预测值为83.33%(65/78),阳性似然比为28.70,阴性似然比为0.57。两者进行配对设计Mc Nemarχ2检验,P=0.014,统计学上尚不能认为两者的检测效果相同。结论 64SCT扫描对房颤患者左房或左心耳血栓检测的特异度高,对左房或左心耳血栓诊断具有重要价值。但64SCT检查左房或左心耳血栓的敏感性不够,在房颤射频消融术前不能完全代替经食道心脏超声预测左房或左心耳血栓。Objective To investigate the application value of 64-slice spiral CT（ 64SCT） scan in detecting thrombi in the left atrial or left atrial appendage（ LAA） in patients with atrial fibrillation.Methods We included atrial fibrillation cases admitted in the department of cardiology of Aerospace Center Hospital from January 2009 to February 2015. There were 89 cases of atrial fibrillation patients received both64 SCT and transesophageal echocardiography（ TEE） examination after admitted. The results of 64 SCT and TEE were compared and analyzed. Results In the 89 patients with atrial fibrillation enrolled,taking TEE as the gold standard,the results of 75 cases of 64 SCT were consistent with the diagnosis of TEE in 84. 27%（ 75 /89）. The diagnostic specificity of 64 SCT for the detection of thrombus in the left atrial or left atrial appendage was 98. 48%（ 65 /66）,the diagnostic sensitivity was 43. 48%（ 10 /23）,the positive predictive value was 90. 91%（ 10 /11）,the negative predictive value was 83. 33%（ 65 /78）,the positive likelihood ratio was 28. 7,and the negative likelihood ratio was 0. 57. However,after analysis,the result of Mc Nemarχ^2test showed P = 0. 014,statistically,less than 0. 05,which means the 64 SCT can not replace TEE.Conclusions 64 SCT scan is a promising noninvasive examination in the detection of left atrial or left atrial appendage thrombi in patients with atrial fibrillation. However in the atrial fibrillation radiofrequency catheter ablation,the sensitivity of 64 SCT is not enough,can not completely replace the TEE in the left atrial or left atrial appendage thrombus assessment.

关 键 词：房颤 左房血栓 左心耳血栓 64排螺旋CT 经食道心脏超声 

分 类 号：R541.75[医药卫生—心血管疾病]