目的: 探讨左心耳CT血管造影(CTA)双期扫描在房颤患者中诊断左心耳血栓的应用价值。方法: 回顾性收集2020年1月至2022年6月房颤患者36例,所有患者均行左心耳(LAA)CTA双期扫描和经食管超声心动图(TEE)检查。以TEE检查结果为“金标准”,分别计算LAA-CTA第一期和第二期诊断LAA血栓的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率,并采用Kappa检验评价LAA-CTA第一期和第二期诊断结果与TTE诊断结果的一致性。结果: LAA-CTA第一期诊断左心耳血栓患者21例,第二期诊断左心耳血栓患者15例,TTE诊断左心耳血栓患者14例;LAA-CTA第一期诊断LAA血栓的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率分别为64.29%、45.45%、42.86%、66.67%及52.78%;LAA-CTA第二期诊断LAA血栓的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率分别为92.86%、90.91%、86.67%、95.24%、91.67%,差异均有统计学意义(P＜0.05)。LAA-CTA第一期诊断左心耳血栓结果与TEE诊断结果一致性一般(Kappa=0.089),而LAA-CTA第二期诊断左心耳血栓结果与TEE诊断结果一致性较好(Kappa=0.827),差异有统计学意义(P＜0.05)。结论: 左心耳CTA双期扫描均能发现LAA血栓,但第二期扫描诊断血栓的敏感性、特异性及诊断符合率均升高,且第二期诊断血栓结果与TEE一致性较好,因此左心耳CTA双期扫描方法在诊断LAA血栓方面具有较高的临床应用价值。
Objective: To investigate the value of left atrial appendage CT angiography (CTA) double phase scan in the diagnosis of left atrial appendage thrombus in patients with atrial fibrillation. Methods: Thirty-six patients with atrial fibrillation were retrospectively collected from January 2020 to June 2022, and all patients underwent left atrial appendage (LAA) CTA double phase scan and transesophageal echocardiography (TEE). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic compliance rate of LAA-CTA phase I and phase II diagnoses of LAA thrombus were calculated using the TEE test as the "gold standard", and the consistency of the LAA-CTA phase I and phase II diagnoses with the TTE diagnoses was evaluated using the Kappa test. Results: Twenty-one patients with left atrial appendage thrombus diagnosed in the first stage of LAA-CTA, 15 patients with left atrial appendage thrombus diagnosed in the second stage, and 14 patients with left atrial appendage thrombus diagnosed by TTE; the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic compliance rate of LAA-CTA phase I for the diagnosis of LAA thrombus were 64.29%, 45.45%, 42.86%, 66.67% and 52.78%, respectively; the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic compliance rate of LAA-CTA phase II for the diagnosis of LAA thrombus were 92.86%, 90.91%, 86.67%, 95.24% and 91.67%, respectively, with statistically significant differences (P＜0.05). The results of LAA-CTA phase I diagnosis of left atrial appendage thrombus were in general agreement with TEE diagnosis (Kappa=0.089), while the results of LAA-CTA phase II diagnosis of left atrial appendage thrombus were in better agreement with TEE diagnosis (Kappa=0.827), with statistically significant differences (P＜0.05). Conclusion: The sensitivity, specificity, and diagnostic compliance rate of the second-stage scan are higher, and the results of the second-stage diagnosis of thrombus are in better agreement with TEE, so the left atrial appendage CTA double phase scan method has higher clinical application value in the diagnosis of LAA thrombus.
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