射频消融术前行CT扫描对心房颤动患者左心耳血栓的诊断价值  

The value of CT scan in diagnosis of left atrial appendage thrombus in patients with atrial fibrillation before radiofrequency ablation

作　　者：李又洁 王明超[1] 

机构地区：[1]天津市第五中心医院放射科,天津300450

出　　处：《中国中西医结合急救杂志》2017年第3期270-273,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市医药卫生科研基金项目（2010KZ23）

摘　　要：目的 探讨心房颤动（房颤）患者射频消融术前行256层螺旋CT心脏双期扫描诊断左心耳（LAA）血栓的临床价值.方法 采用前瞻性研究方法,选择天津市第五中心医院2015年10月至2016年7月收治的拟行房颤射频消融术的患者36例,先行CT心脏双期扫描、后经食管超声心动图（TEE）确诊血栓.第一期心脏CT扫描采取智能跟踪法确定延迟时间;第二期心脏CT扫描确定85 s为延迟时间;以TEE为金标准评价两期CT确诊LAA血栓的价值.结果 第一期CT扫描发现LAA低密度充盈缺损5例,第二期CT扫描仍呈现充盈缺损,诊断LAA血栓3例（其中2例后经TEE确诊为血栓、1例为烟雾样回声即血栓前状态）,2例为假的充盈缺损（后经TEE确诊为烟雾样回声即血栓前状态）.TEE确诊2例为真实血栓,3例为烟雾样回声,判定为血栓前状态.以TEE为诊断血栓的金标准,计算得出：第一期CT扫描诊断LAA血栓的敏感度为100.0%,特异度为91.2%,阳性预测值为40.0%,阴性预测值为100.0%;第二期CT扫描诊断LAA血栓的敏感度、特异度、阳性预测值、阴性预测值分别为100.0%,97.1%,66.7%,100.0%;第二期CT的Kappa系数大于第一期CT的Kappa系数（0.898比0.739）,差异有统计学意义（P〈0.05）.结论 CT心脏双期扫描均能发现LAA血栓及血栓前状态,经第二期CT扫描诊断血栓的阳性预测值明显升高,且第二期CT诊断血栓与TEE一致性高于第一期CT,故多层螺旋CT心脏双期扫描方法诊断LAA血栓有较高的应用价值.Objective To evaluate the clinical value of cardiovascular dual-phase scan of 256-slice spiral CT in diagnosis of left atrial appendage （LAA） thrombus before radiofrequency ablation in patients with atrial fibrillation. Methods A prospective study was conducted. Thirty-six patients with atrial fibrillation being prepared to undergo radiofrequency ablation admitted to the Fifth Central Hospital of Tianjin from October 2015 toJuly 2016 were enrolled, they were scanned using dual-phase cardiovascular protocol of 256-slice spiral CT, and then trans-esophageal echocardiography （TEE） was performed for the definite diagnose of thrombus. In the first phase of cardiac CT, the intelligent tracking method was used to determine the delayed time; in the second phase cardiac CT scan, 85 seconds was confirmed as the delayed time; TEE as the golden standard was used to evaluate the value of dual-phase CT in definite diagnosis of LAA thrombus.Results LAA low density filling defect was discovered in 5 patients in the first phase CT scan, the CT scan in the second phase, the filling defect still existed, and the diagnosis of LAA thrombus in 3 patients was made （of them 2 cases after TEE examination were diagnosed definitely as LAA thrombus, and the echo in 1 case was smoke-like on TEE, being at pre-thrombus status）, 2 cases were confirmed as pseudo-filling defects （afterwards, their diagnosis was confirmed as pre-thrombus status because the echo shown on TEE was smoke-like）. Two patients were confirmed as true thrombi on TEE, and there were 3 patients diagnosed as pre-thrombus state by TEE because of their echo smoke-like. TEE was used as the golden standard for diagnosis of thrombus, the following indexes could be calculated： in the first phase, the sensitivity of using CT scan to diagnose LAA thrombus was 100.0%, the specificity 91.2%, positive predictive value （PPV） 40.0%, and negative predictive value （NPV） 100.0%; while in the second phase of using CT scan for diagnosis of LAA thrombus, the above inde

关 键 词：256层螺旋CT 心脏双期扫描 左心耳血栓 

分 类 号：R651.15[医药卫生—外科学]