Yoshida H, Tsunoda K, Yamada Z, Morooka N, Watanabe S, Masuda Y, Inagaki Y, Nakanishi S
J Cardiogr. 1982 Sep;12(3):645-54.
The usefulness of computed tomography (CT) in the diagnosis of an intracardiac mural thrombus was examined by comparing with two-dimensional echocardiography (2-DE), left ventricular cineangiography (LVG), and operative findings. The following results were obtained: 1) Left atrial thrombi: Among 43 cases of valvular disease with mitral stenosis, left atrial thrombi were noted in 10 cases (13 regions) by CT. Out of these 13 regions, 2-DE detected six regions (Fig. 2). Among 11 patients who underwent operation, thrombi were present in four (six regions). Of these six regions, thrombus was suspected in one region and another one was undetectable, but detected in the remaining four regions by CT and was in good accord with the operative findings (Table 1). Left atrial thrombi were detected in two of 138 cases of coronary heart disease, and in one of 26 cases of cardiomyopathy by CT. 2) Left ventricular thrombi: Left ventricular thrombi were detected in 26 of 122 cases of myocardial infarction (21%) by CT, and had a particularly high incidence in the cases having a ventricular aneurysm (Fig. 4). Of 81 cases in which 2-DE was performed, left ventricular thrombi were detected in 13 cases by both CT and 2-DE, and were not detected in 59 cases by both methods. In nine cases 2-DE diagnosis was not consistent with CT (Table 2). Of 76 cases in which left ventricular cineangiography was performed, left ventricular thrombi were detected in 12 cases by both CT and LVG, and were not detected in 58 cases by both methods. There were six cases of disaccord between 2-DE and CT (Table 2). In two of five cases of congestive cardiomyopathy, left ventricular thrombi were noted by CT. CT was able to detect thrombi in the left atrial appendage, the left atrial lateral wall (Fig. 6), and the regions near the left ventricular apex, which were difficult to be investigated by 2-DE (Fig. 8). CT was, in particular, superior in depicting the size, location and property of thrombi. In addition, CT was able to depict clearly a small thrombus in the left ventricular apex to the extent of, or better than, left ventriculography. Therefore, contrast enhanced CT is a useful diagnostic method for the detection of intracardiac mural thrombi.
通过与二维超声心动图（2-DE）、左心室心血管造影（LVG）及手术结果相比较，研究了计算机断层扫描（CT）在诊断心内附壁血栓中的应用价值。获得以下结果：1）左心房血栓：在43例二尖瓣狭窄瓣膜病患者中，CT发现10例（13个区域）存在左心房血栓。在这13个区域中，2-DE检测到6个区域（图2）。11例接受手术的患者中，4例（6个区域）存在血栓。在这6个区域中，CT怀疑1个区域有血栓，另1个区域未检测到，但在其余4个区域检测到血栓，且与手术结果高度一致（表1）。CT在138例冠心病患者中检测到2例左心房血栓，在26例心肌病患者中检测到1例。2）左心室血栓：CT在122例心肌梗死患者中的26例（21%）检测到左心室血栓，在有室壁瘤的病例中发生率尤其高（图4）。在81例行2-DE检查的病例中，CT和2-DE均检测到左心室血栓的有13例，两种方法均未检测到的有59例。9例中2-DE诊断与CT不一致（表2）。在76例行左心室心血管造影的病例中，CT和LVG均检测到左心室血栓的有12例，两种方法均未检测到的有58例。2-DE与CT之间有6例不一致（表2）。在5例充血性心肌病患者中的2例，CT发现有左心室血栓。CT能够检测到2-DE难以检查的左心耳、左心房侧壁（图6）及左心室心尖附近区域的血栓（图8）。CT在描绘血栓的大小、位置及特征方面尤其优越。此外，CT能够清晰地描绘左心室心尖处的小血栓，其程度与左心室造影相当或更好。因此，增强CT是检测心内附壁血栓的一种有用的诊断方法。
