摘要
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.
Abstract
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,nega-tive 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 pa-tients with left atrial appendage thrombus diagnosed by TTE;the sensitivity,specificity,positive pre-dictive 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 compli-ance 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 compli-ance 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 meth-od has higher clinical application value in the diagnosis of LAA thrombus.
维普
万方数据