左心房CT重建和经食管超声在诊断左心房血栓中的应用价值比较

A COMPARATIVE STUDY OF THE VALUE OF LEFT ATRIAL CT RECONSTRUCTION AND THE DIAGNOSIS OF LEFT ATRIAL THROMBUS BY ECHOCARDIOGRAPHY

目的比较左心房CT重建和经食管超声在左心房血栓诊断中的准确性并分析各自应用价值。方法选取118例拟行导管消融术治疗的房颤患者作为研究对象,分别行左心房CT重建和经食管超声检测;观察两种方法检测下房颤患者影像图像,比较左心房血栓检出及检出者择期导管消融术治疗后动脉栓塞及死亡情况。结果以经食管超声检出结果为标准,左心房CT重建符合率88.98%,诊断特异性为92.52%。诊断灵敏度为54.55%,阳性预测值为87.94%,阴性预测值为67.06%,阳性似然比为7.295,阴性似然比为0.833,χ2=0.403,P〉0.05。两种检测均一致诊断为血栓的105例患者血栓长径均着于左心房壁上,其他影像特征一致,多呈片状,最长直径21~30mm分布较多;常规抗凝治疗后,导管消融术治疗成功率99.05%,且术后无一例发生动脉血栓及死亡。结论经食管超声是诊断左心房血栓的金标准,但操作难度及费用均较高,左心房CT重建能一次成像显示患者左心房形态,且符合率及特异性均较高,诊断结果与经食管超声相符,对指导房颤患者治疗具有重要的价值。

Objective To compare the accuracy of CT reconstruction of left atrium and the diagnosis of left atrial thrombus and analyze their application value.Methods A total of 118 cases of quasi catheter ablation of atrial fibrillation patients were as the research subjects,the CT reconstruction of the left atrium and transesophageal ultrasound detection were performed respectively.Two kinds of methods for the detection of atrial fibrillation in patients with images were observed,and left atrial thrombus detection and detection undergoing catheter ablation therapy after artery embolism and death were compared.Results The results of transesophageal ultrasound were as the standard,the coincidence rate of the CT reconstruction of the left atrium was 88.98%,the diagnostic specificity was 92.52%,diagnostic sensitivity was 54.55%,the positive predictive value of 87.94% and negative predictive value for 67.06%,the positive likelihood ratio for7.295,negative likelihood ratio was 0.833,χ2=0.403,P〉0.05.The two detection tests were consistent with the diagnosis of thrombus in the left atrial wall of 105 patients,other imaging features were consistent,and more than one chip,the longest diameter of 21~30mm distribution more;conventional anticoagulant therapy,catheter ablation treatment success rate of 99.05%,and 1 case without postoperative arterial thrombosis and death.Conclusion The diagnosis of left atrial thrombus is the gold standard of diagnosis of left atrial thrombus,but the difficulty and cost of operation are relatively high.Left atrium CT reconstruction can be a single imaging display of left atrium shape,and the coincidence rate and specificity are higher,the diagnosis results and the esophagus ultrasound are consistent.