He Chun-Li, Wang Zhao-Qian, Jia Chong-Fu, Cong Tao, Zhang Liang, Yang Zhi-Qiang, Sun Xi-Xia, Sun Si-Yao
Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, 222#, Zhong Shan Road, Dalian, 116011, Liaoning, China.
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222#, Zhong Shan Road, Dalian, 116011, Liaoning, China.
Int J Cardiovasc Imaging. 2018 Jul;34(7):1147-1154. doi: 10.1007/s10554-018-1313-5. Epub 2018 Feb 19.
To investigate the capacity of biphasic cardiac CT (CCT) for qualitative and quantitative evaluation of different grades of left atrial appendage spontaneous echo contrast (LAASEC). The study included 267 inpatients with confirmed atrial fibrillation who underwent both CCT and transesophageal echocardiography (TEE). CT numbers for LAA, ascending aorta (AA), and left atrium (LA) were identified, and ROC curves for LAA, LAA/AA, and LAA/LA were plotted. With TEE as the standard, the sensitivity, specificity, PPV, NPV, and accuracy of CCT for LAASEC grade ≥ 1 were 60.3, 92.9, 92.4, 64.8, and 75.7%; and for grade ≥ 2 were 100.0, 84.4, 71.4, 100.0, and 88.8% respectively. The values of LAA, LAA/AA, and LAA/LA were significantly larger in LAASEC grade 0 versus 1 and in grade 1 versus 2, but were similar in grades 2 and 3 or in grades 3 and 4. The values of LAA/AA were larger in grade 2 versus 4. When the cutoff value for LAA/AA = 0.897, sensitivity, specificity, PPV, NPV, and accuracy of CCT for LAASEC grade ≥ 1 was 89.6, 83.2, 87.9, 85.5, and 86.9% and with a cutoff for LAA/AA of 0.524, the sensitivity, specificity, PPV, NPV, and accuracy for LAASEC grade ≥ 2 was 98.7, 92.7, 84.1, 99.4, and 94.4%. Although CCT showed limited diagnostic accuracy for grade 1 LAASEC, grade ≥ 2 LAASEC could be excluded when there was no LAA filling defect on first-phase CCT, and TEE can be avoided. CCT has an excellent accuracy in diagnosing LAASEC, and quantitative analysis (in particular LAA/AA) is superior.
探讨双期心脏CT（CCT）对不同程度左心耳自发显影（LAASEC）进行定性和定量评估的能力。该研究纳入了267例确诊房颤的住院患者，这些患者均接受了CCT和经食管超声心动图（TEE）检查。确定左心耳（LAA）、升主动脉（AA）和左心房（LA）的CT值，并绘制LAA、LAA/AA和LAA/LA的ROC曲线。以TEE为标准，CCT对LAASEC≥1级的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为60.3%、92.9%、92.4%、64.8%和75.7%；对≥2级的分别为100.0%、84.4%、71.4%、100.0%和88.8%。LAASEC 0级与1级以及1级与2级相比，LAA、LAA/AA和LAA/LA的值显著更大，但2级和3级或3级和4级的值相似。2级与4级相比，LAA/AA的值更大。当LAA/AA的截断值为0.897时，CCT对LAASEC≥1级的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为89.6%、83.2%、87.9%、85.5%和86.9%；当LAA/AA的截断值为0.524时，对LAASEC≥2级的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为98.7%、92.7%、84.1%、99.4%和94.4%。尽管CCT对1级LAASEC的诊断准确性有限，但当首次CCT检查时无LAA充盈缺损时可排除≥2级LAASEC，从而可避免TEE检查。CCT在诊断LAASEC方面具有出色的准确性，定量分析（尤其是LAA/AA）更具优势。
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