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Published on: February 8, 2022
Multidetector computed tomography for the detection of left atrial appendage thrombus: a comparative study with
Michael D Shapiro1, Tomas G Neilan, Davinder S Jassal
1Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Multidetector computed tomography (MDCT) has limited diagnostic performance for detecting left atrial appendage (LAA) thrombus compared to transesophageal echocardiography. However, MDCT
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Left atrial appendage (LAA) thrombus is a significant risk factor for thromboembolic events.
- Accurate detection of LAA thrombus is crucial for guiding anticoagulation therapy.
Purpose of the Study:
- To evaluate the diagnostic performance of multidetector computed tomography (MDCT) in detecting left atrial appendage (LAA) thrombus.
- To compare MDCT findings with transesophageal echocardiography (TEE).
Main Methods:
- Qualitative assessment of LAA filling defects on MDCT in 43 patients.
- Quantitative evaluation using the ratio of LAA apex to aortic root CT attenuation.
- Comparison of MDCT results with TEE findings.
Main Results:
- Qualitative MDCT showed 70% sensitivity and 82% specificity for LAA thrombus.
- Quantitative MDCT demonstrated 80% sensitivity and 73% specificity.
- MDCT could not differentiate thrombus from spontaneous echo contrast.
Conclusions:
- MDCT has limitations in definitively detecting LAA thrombus.
- MDCT's high negative predictive value may benefit select high-risk patients.
Objective:
To determine the diagnostic performance of multidetector computed tomography (MDCT) for the detection of left atrial appendage (LAA) thrombus as compared with transesophageal echocardiography.
Methods:
Multidetector computed tomography was evaluated in 43 patients qualitatively for the presence or absence of a filling defect in the LAA and compared with transesophageal echocardiography. Additionally, a ratio of the mean computed tomographic attenuation in the LAA apex to the mean computed tomographic attenuation in the aortic root was used for quantitative evaluation.
Results:
A filling defect visualized in the LAA by MDCT corresponded to a sensitivity of 70% (7/10), a specificity of 82% (27/33), and a negative predictive value of 90% (27/30) for detection of LAA thrombus. When using quantitative parameters, MDCT demonstrated a sensitivity of 80% (8/10), a specificity of 73% (24/33), and a negative predictive value of 92% (24/26). Multidetector computed tomography was not able to differentiate LAA thrombus from spontaneous echo contrast by either visual evaluation or by quantitative parameters.
Conclusions:
Multidetector computed tomography remains limited for the detection of LAA thrombus. However, a subgroup of patients at very high risk for LAA thrombus may benefit from the high negative predictive value of cardiac MDCT.
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