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Evaluation of left ventricular thrombi by contrast-enhanced computed tomography and two-dimensional echocardiography
Insights
Contrast-enhanced computed tomography (CT) is a useful tool for detecting left ventricular (LV) thrombus, especially when 2-dimensional echocardiography (2-D echo) has limitations. CT offers valuable insights into LV thrombus presence, location, and size.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Left ventricular (LV) thrombus is a significant complication in patients with coronary artery disease.
- Accurate detection and characterization of LV thrombus are crucial for guiding treatment and preventing embolic events.
Purpose of the Study:
- To compare the diagnostic accuracy of contrast-enhanced computed tomography (CT) and 2-dimensional echocardiography (2-D echo) in evaluating LV thrombus.
- To assess the utility of CT as an alternative or complementary imaging modality to 2-D echo for LV thrombus detection.
Main Methods:
- Retrospective analysis of 13 patients with coronary artery disease and confirmed LV thrombus.
- Comparison of findings from contrast-enhanced CT and 2-D echo in terms of thrombus presence, location, size, and associated LV abnormalities.
- Evaluation of discordant results and identification of potential causes for discrepancies.
Main Results:
- Concordant findings between CT and 2-D echo in 8 out of 13 patients regarding LV thrombus.
- Discordant results in 5 patients, including false-negative 2-D echo due to apical visualization issues and false-negative CT due to inadequate contrast.
- CT demonstrated utility in cases where 2-D echo visualization was suboptimal or results were equivocal.
Conclusions:
- Contrast-enhanced CT is a valuable technique for evaluating left ventricular thrombus.
- CT may be particularly beneficial when 2-D echocardiography is technically limited or provides equivocal results.
- CT can aid in accurate thrombus characterization, complementing traditional echocardiographic methods.
Abstract:
Contrast-enhanced computed tomography (CT) was compared with 2-dimensional echocardiography (2-D echo) for evaluation of left ventricular (LV) thrombus. Thirteen patients with coronary artery disease who had LV thrombus initially documented by 1 of the 2 techniques were then studied with the other technique. The findings of the studies were concordant in 8 of 13 patients, with a similar description of the presence, location and size of the LV thrombus and associated regional LV wall abnormalities. In 5 of 13 patients, the 2 techniques produced discordant data. Of these, 2 patients had false-negative results on 2-D echo owing to poor visualization of the LV apex; 1 patient had a false-positive result on 2-D echo related to misinterpretation of a prominent papillary muscle; 2 patients had false-negative CT results, 1 related to insufficient contrast infusion. The findings demonstrate that CT is a useful technique for evaluating LV thrombus, and may be particularly helpful when 2-D echo is technically limited or equivocal.