双期心脏CT成像在左心耳自发显影(≥2级)中的诊断价值  

Value of dual-phase cardiac CT scanning in the diagnosis of left atrial appendage spontaneous echo contrast (≥2 grade)

作　　者：刘波[1] 徐俊青 赵埴飚[1] 贾崇富[3] 

机构地区：[1]兖矿集团总医院放射科,山东273500 [2]山东曲阜市中医院CT室,山东273165 [3]大连医科大学附属第一医院心脏CT检查科,辽宁116011

出　　处：《放射学实践》2017年第11期1152-1155,共4页Radiologic Practice

摘　　要：目的:以经食道超声心动图(TEE)为金标准,探讨双期心脏CT(CCT)定性及定量评估2级以上左心耳自发显影(LAASEC)的临床价值。方法:本院明确诊断房颤且行CCT及经食道超声心动图(TEE)两项检查的住院患者267例。以TEE为金标准,计算CCT定性评估LAASEC(≥2级)的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及诊断符合率。测量左心耳(LAA)及升主动脉(AA)CT值,计算LAA/AA,绘制LAA/AA的ROC曲线。结果:TEE诊断LAASEC 0~1级患者共192例,CCT阴性162例(84.4%),阳性30例(15.6%)。LAASEC 2~4级75例,CCT全部为阳性。以TEE为金标准,CCT定性检测LAASEC(≥2级)的敏感度、特异度、PPV、NPV及符合率分别为100.0%、84.4%、71.4%、100.0%及88.8%。LAA/AA最佳截断点为0.524时,CCT评价LAASEC(≥2级)的敏感度、特异度、PPV、NPV及符合率分别为98.7%、92.7%、84.1%、99.4%及94.4%。结论:双期CCT在评估LAASEC(≥2级)方面具有重要的临床排除和预警价值。当CCT首期左心耳部无充盈缺损时,可以排除2~4级LAASEC的可能,避免不必要的TEE检查。Objective：Taking transesophageal echography （TEE） as gold standard,to study the clinical value of dualphase cardiac CT （CCT） in the quantitative evaluation of left atrial appendage spontaneous echo contrast （LAASEC） （≥2 grade）. Methods： 267 patients with atrial fibrillation undertook both CCT and transesophageal echo （TEE） examination. U- sing TEE as the gold standard,the sensitivity, specificity,negative predictive value （NPV）, positive predictive value （PPV） and accuracy of CCT in the quantitative evaluation of LAASEC were studied. In addition, the CT value of left atrial appendage （LAA） and ascending aorta （AA） were measured,then the ratio of CT values （LAA/AA） was calculated,and ROC of LAA/AA was drawn. Results：Of the 267 patients, totally 162 patients were diagnosed as Grade 0 ~ 1 LAASEC by TEE, the CCT diagnosis was negative in 162 patients （84.4%）,and positive in 30 patients （15.6%）. A total of 75 patients were di agnosed as Grade 2~4 LAASEC by TEE,which were all positive on CCT. Taking TEE as the gold standard,the sensitivi ty,specificity,PPV,NPV and accuracy of CCT in displaying LAASEC was 100.0% ,84.3%,71.4% ,100.0% and 88.1% respectively. On the basis of ROC curve,using the optimal cutoff value as 0. 542 for the LAA/AA ratio,quantitative identi fication of LAASEC （≥grade 2） yielded the sensitivity, specificity, PPV NPV and accuracy as 98. 7%, 92. 7%, 84.1%, 99.4% and 93.7% respectively. Conclusion： Dual phase CCT has significant values in exclusion and warning of LAASEC （grade 2~4） in clinical practice. When no filling defect was displayed in early-phase of CCT,Grade 2~4 spontaneous dis play of LAASEC could be ruled out and unnecessary TEE could be prevented.

关 键 词：自发显影 心脏CT 经食道超声心动图 房颤 左心耳 

分 类 号：R541.75[医药卫生—心血管疾病] R816.2[医药卫生—内科学]