256层螺旋CT心脏双期扫描诊断左房耳血栓的应用研究  

Diagnosis of the Left Atrial Appendage Thrombus with Dual-phase Cardiovascular Protocol of 256-slice Spiral CT

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CT室

出　　处：《中国医学计算机成像杂志》2017年第6期517-520,共4页Chinese Computed Medical Imaging

基　　金：滨海新区科研基金;No.2013KJXQ04~~

摘　　要：目的:探讨256层螺旋CT心脏双期扫描诊断左房耳血栓的临床价值。方法:选取本院近年来收治的拟行房颤射频消融术的36例患者,其中男21例,女15例,年龄32~66岁(平均48.6±9.3岁)。所有患者入选前瞻性试验: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85s为延迟时间;以TEE为金标准确诊两期CT发现的左房耳血栓。结果:第一期CT扫描发现左房耳低密度充盈缺损5例(5/36,13.9%),第二期CT扫描仍呈现充盈缺损,诊断左房耳血栓3例(3/5,60%)(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(2/5,40%)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(5.6%,2/36)为真实血栓,3例(8.3%,3/36)为烟雾样回声、判定为血栓前状态。以TEE诊断血栓为金标准,计算得出:第一期CT扫描诊断左房耳血栓灵敏度为100%,特异度为91.2%,阳性预测值40%,阴性预测值为100%;第二期CT扫描诊断左房耳血栓的灵敏度、特异度、阳性预测值、阴性预测值分别为100%、97.1%、66.7%、100%;Kappa系数0.898(第二期CT)>Kappa系数0.739(第一期CT),且P<0.05,有统计学意义。结论:CT心脏双期扫描均能发现左房耳血栓及血栓前状态,经第二期CT扫描诊断血栓的阳性预测值明显提升,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左房耳血栓有较高的应用价值。Purpose： To evaluate the value of dual-phase cardiovascular protocol of 256-slice spiral CT in diagnosis of left atrial appendage thrombus. Methods： Thirty-six cases of atrial fibrillation patients, who were prepared to undergo radiofrequency catheter ablation in our hospital in recent years, were enrolled. These cases included 21 men and 15 women, aged 32 to 66 （mean 48.6J：9.3） years. All patients were scanned with dual-phase cardiovascular protocol by 256-slice spiral CT, and then transesophageal echocardiography （TEE） was performed to confirm the diagnosis of thrombus. The first phase scan was performed using a test bolus technique for scan timing. The delayed phase scan was performed 85s after the beginning of contrast medium injection. Using TEE as the golden standard, the diagnosis rate of thrombus on first phase and second phase scan images were evaluated.Results： Five （5/36, 13.9%） patients had filling defects on the first phase study. Three （3/5, 60%） patients had filling defects and confirmed as thrombi on second phase. Two patients were shown with and confirmed as true thrombi on TEE, 1 patient was shown a smoke-like echo and diagnosed as clot on TEE. Two patients （2/5, 40%） were confirmed with pseudo-filling defects on second-pass （they were seen as smoke-like echoes and diagnosed as clot on TEE）. Two （5.6%, 2/36） patients were confirmed with true thrombi on TEE, 3 patients （8.3%, 3/36） were shown smoke-like echoes and diagnosed as clot on TEE. Using TEE as the golden standard, the sensitivity, specificity, positive predictive values （PPV） and negative predictive values （NPV） of first phase scans in detection of true thrombus were 100%, 91.2%, 40%, 100%, respectively; and those of the second phase scans were 100%, 97.1%, 66.7%, 100%. The Kappa coefficient of the second phase was larger than that of first phase （0.898 vs. 0.739, P〈0.05）. Conclusion： Dual-phase cardiovascular protocol of CT is a reliable imaging method for the detection of LAA thro

关 键 词：体层摄影术 X线计算机 心脏双期扫描 左房耳血栓 

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