房颤患者CCTA左心耳充盈缺损中血栓征象分析  

Analysis of Left Atrial Appendage Thrombus Signs in Atrial Fibrillation Cases with Left Atrial Appendage Filling Defects Through Cardiac Computed Tomography Angiography

作　　者：刘家骥 王倩 李有权 陈剑 方进 LIU Jiaji;WANG Qian;LI Youquan(Department of Radiology,the First People's Hospital of Zunyi City(the Third Affiliated Hospital of Zunyi Medical University),Zunyi,Guizhou Province 563000,P.R.China)

机构地区：[1]遵义市第一人民医院/遵义医科大学第三附属医院影像科,563000 [2]遵义市第一人民医院/遵义医科大学第三附属医院心内科,563000

出　　处：《临床放射学杂志》2023年第11期1741-1746,共6页Journal of Clinical Radiology

基　　金：贵州省卫生健康委科学技术基金项目(编号:gzwjkj2019-1-208);遵义市科学技术局联合科技研发资金项目[遵市科合HZ字(2019)143号]。

摘　　要：目的研究心房颤动(AF)患者心脏CT血管造影(CCTA)左心耳(LAA)充盈缺损病例中提示左心耳血栓(LAAT)的影像征象。方法搜集行CCTA检查并出现LAA充盈缺损的AF患者64例,分析充盈缺损区与正常密度心腔交界面的形状、走行和清晰度,充盈缺损区密度均匀度,环绕征、飘带征等征象,与最终结果对照,分析上述征象诊断LAA的敏感度(TPR)、特异度(TNR)、阳性预测值(PPV)、阴性预测值(NPV)。结果64例最终诊断LAAT 27例,所有征象中,交界面走行的TPR(100%)和NPV(100%)最高,TNR(59%)较低;环绕征的TNR(100%)和PPV(100%)最高,TPR(33%)较低,交界面形状的TPR(78%)和TNR(73%)最为均衡;飘带征TPR(11%)和TNR(70%)均较低,但征象特殊;通过交界面形状与清晰度两征象联合应用,可显著提高TNR(95%)和PPV(90%),而交界面形状、清晰度与密度均匀度三征象联合应用,可获得除环绕征外最佳的TNR(97%)和PPV(94%)。结论对LAA出现充盈缺损的AF患者重点从交界面走行、形态、清晰度、密度均匀度进行综合分析,交界面走行呈曲面且形态不规则、密度不均匀,是LAAT的高风险征象,环绕征是LAAT的特异性征象;飘带征可能预示LAA处于高凝状态,值得进一步研究。Objective To study imaging characteristics of left atrial appendage thrombus(LAAT)in atrial fibrillation(AF)cases with left atrial appendage(LAA)filling defects through cardiac computed tomography angiography(CCTA).Methods Sixty-four AF patients who underwent CCTA and presented with filling defects of the LAA were selected for this study.The shape,and clarity of the interface of the flling defect area and the cardiac chamber with normal density,how the interface goes,whether the density of the filling defect area is uniform,the circumference signs and the cortical ribbon signs were analyzed.Besides,the sensitivity(TPR),specificity(TNR),positive predictive value(PPV),and negative predictive value(NPV)of the above signs for the diagnosis of LAA were studied.Results LAAT was diagnosed in 27 of 64 cases.The highest TPR(100%)and NPV(100%)and lower TNR(59%)were found when using how the interface goes to check the state of LAA.The highest TNR(100%)and PPV(100%)and lower TPR(33%)were found when circumference signs were used for checking.The mid-level of TPR(78%)and TNR(73%)was found when the interface shape was used for examination.The lowest TPR(11%)and TNR(70%)were seen when the cortical ribbon signs were used,but the signs were special.Through combined use of interface shape and clarity,TNR and PPV are significantly improved to 95%and 90%,while the best TNR(97%)and PPV(94%)which are only second to circumference signs are found when interface shape,clarity and density uniformity signs are jointly applied.Conclusion Through comprehensive analysis of how the interface goes,shape,clarity or density uniformity on AF patients with LAA flling defects,it suggests a high possibility of LAAT when the interface is curved,irregular in shape and non-uniform in density.Circumference signs are specificity signs of LAAT,and the cortical ribbon signs may indicate that LAA is in a hypercoagulable state,which needs to be further studied.

关 键 词：心房颤动 心脏CT 左心耳 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]