Department of Cardiology, First Affiliated Hospital of Harbin Medical University, 23 Youzheng St, Nangang District, 150001 Harbin City, Heilongjiang Province, China.
J Ultrasound Med. 2014 Jan;33(1):83-91. doi: 10.7863/ultra.33.1.83.
We investigated whether transesophageal echocardiography (TEE) assisted with a computer-aided diagnostic (CAD) algorithm was superior to TEE in diagnosing left atrial (LA)/left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) in a single prospective study.
Transesophageal echocardiography was performed in patients with AF, and images were reconstructed. Gray level co-occurrence matrix-based features were calculated and then classified using an artificial neural network. The original data and processed images by the CAD system were studied by 5 radiologists independently in a blind manner. The diagnostic performance of each radiologist was evaluated.
One hundred thirty patients with AF were investigated. Thirty-one patients (23.9%) had a diagnosis of LA/LAA thrombi. The mean sensitivity ± SD of TEE for LA/LAA thrombi was 0.933 ± 0.027, which was noticeably improved by CAD (0.955 ± 0.021; P < .05). The specificity of TEE was 0.811 ± 0.055, which was markedly lower than that by TEE plus CAD (0.970 ± 0.009; P < .05). The positive predictive value of TEE was low (0.613 ± 0.073) compared to that of TEE plus CAD (0.908 ± 0.027; P < .001), whereas the negative predictive values were comparable for TEE, CAD, and TEE plus CAD. Diagnosis of an LA/LAA thrombus by TEE plus CAD had a higher accuracy rate (0.966 ± 0.011) than that by TEE (0.840 ± 0.047; P < .01). The mean area under the receiver operating characteristic curve (Az) for TEE was 0.834 ± 0.009 (95% confidence interval [CI], 0.815-0.852), which was markedly lower than the Az for TEE plus CAD (0.932 ± 0.005; 95% CI, 0.921-0.943). The use of CAD significantly improved the Az values for all 5 radiologists (P < .001).
The CAD algorithm significantly improves the diagnostic accuracy of TEE for LA/LAA thrombi in patients with AF.
我们旨在研究经食管超声心动图（TEE）联合计算机辅助诊断（CAD）算法是否优于 TEE 单独用于诊断房颤（AF）患者左心房（LA）/左心耳（LAA）血栓。
对 AF 患者进行 TEE 检查，并进行图像重建。计算灰度共生矩阵特征，然后使用人工神经网络进行分类。5 名放射科医生以盲法独立研究原始数据和 CAD 系统处理后的图像。评估每位放射科医生的诊断性能。
共纳入 130 例 AF 患者。31 例（23.9%）患者诊断为 LA/LAA 血栓。TEE 诊断 LA/LAA 血栓的平均敏感度±标准差为 0.933±0.027，CAD 后明显提高（0.955±0.021；P＜0.05）。TEE 的特异性为 0.811±0.055，明显低于 TEE 联合 CAD（0.970±0.009；P＜0.05）。TEE 的阳性预测值较低（0.613±0.073），低于 TEE 联合 CAD（0.908±0.027；P＜0.001），而 TEE、CAD 和 TEE 联合 CAD 的阴性预测值相当。TEE 联合 CAD 诊断 LA/LAA 血栓的准确率（0.966±0.011）高于 TEE（0.840±0.047；P＜0.01）。TEE 的受试者工作特征曲线下面积（Az）平均值为 0.834±0.009（95%置信区间[CI]，0.815-0.852），明显低于 TEE 联合 CAD（0.932±0.005；95%CI，0.921-0.943）。CAD 的应用显著提高了所有 5 名放射科医生的 Az 值（P＜0.001）。
CAD 算法可显著提高 TEE 诊断 AF 患者 LA/LAA 血栓的准确性。
