多层螺旋CT与经食管超声心动图检测心房颤动患者左心房血栓对比

A comparison between multislice spiral computed tomography and transesophageal echocardiography in detection of left atrial thrombus in patients with atrial fibrillation

目的 ：探讨多层螺旋CT（MSCT）与经食管超声心动图（TEE）在检测心房颤动（房颤）患者左心房血栓的价值。方法：收集我院心内科2014年1月1日至2015年6月30日住院拟行房颤射频消融手术病例,在同一次住院期间均行MSCT与TEE检查,搜集2种检查方法检测血栓的结果,比较2种方法的敏感度和特异度。结果：MSCT与TEE诊断符合的为190例,其中6例2种方法均诊断为血栓,余184例均未发现血栓,诊断符合率为94.1%。MSCT检测血栓阳性或可疑阳性的8例患者,TEE则提示左心房及左心耳内淤血表现、云雾状影、絮状回声或未见明显血栓。另外4例TEE诊断为血栓者中1例为左心房前上壁附壁血栓、3例为左心耳少量血栓,而MSCT诊断未见血栓。以TEE为＂金标准＂,MSCT检测血栓灵敏度60.0%,特异度95.8%,阳性预测值42.9%,阴性预测值97.9%,阳性似然比14.4,阴性似然比0.42。经过四格表配对χ^2检验,χ^2=45.936,P〈0.01,κ=46.9%。结论：MSCT与TEE诊断左心房内血栓符合率较高,前者对血栓检测阴性预测值较高,而后者更有利于鉴别血液淤积与血栓。

Objective To analyze the value of multislice spiral computed tomography（MSCT） and transesophageal echocardiography（TEE） in detection of left atrial thrombus in patients with atrial fibrillation. Methods Hospitalized atrial fibrillation patients undergone radiofreqrency ablation from January 1st 2014 to June 30 th 2015 were enrolled. MSCT and TEE were performed, and the results of the two methods for detecting thrombus were analyzed and the sensitivity and specificity were compared. Results MSCT and TEE were coincident in diagnosis of atrial thrombus in 190 cases,among which 6 cases were diagnosed as having thrombus and the remaining 184 cases with no thrombus found. Eight cases were detected as thrombus positive or suspected positive by MSCT, while TEE showed stagnation, cloudy or flocculent echo and no obvious thrombus was found. In other 4 cases, one was diagnosed as left atrial antero-superior wall thrombus and 3 as a little thrombus in the left atrial appendage by TEE, while no thrombus was found by MSCT.The diagnosis coincidence rate between MSCT and TEE was 94.1%. When TEE was regarded as gold standard, the sensitivity of MSCT for detecting thrombus was 60.0% and the specificity was 95.8%, the positive predictive value was42.9%, the negative predictive value was 97.9%, the positive likelihood ratio was 14.4 and the negative likelihood ratio was 0.42. For fourfold table paired chi-square test, the χ^2=45.936, P〈0.01 and κ =46.9%. Conclusions MSCT diagnosing left atrial thrombus was in high coincidence with TEE, and the former had higher negative predictive value and the latter was more conducive for identify blood stagnation and thrombus.