Clinical application value of MSCT in diagnosis of left atrial thrombosis and its comparison with TEE
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摘要:
目的探讨多层螺旋CT（MSCT）及经食管超声心动图（TEE）诊断左心房血栓的临床应用价值。 方法选取2019年1月~ 2020年5月在我院治疗的心房颤动患者150例，接受MSCT及TEE检查，分析MSCT诊断左心房血栓的价值。 结果22例发生左心房血栓，发生率为14.67%；有左心房血栓患者高血压比例为81.82%，高于无左心房血栓患者（P < 0.05）；有和无左心房血栓患者性别、年龄、类型及糖尿病比例比较差异无统计学意义（P>0.05）；MSCT诊断与TEE结果Kappa值为0.617（P < 0.05），MSCT诊断左心房血栓的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为77.27%、91.41%、89.33%、60.71%和95.90%；有左心房血栓患者CHA2DS2-VASc评分≥2分的比例为72.73%，明显高于无左心房血栓患者（P < 0.05）；以CHA2DS2-VASc评分≥2分标准，诊断左心房血栓的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为72.73%、82.81%、81.33%、40.00%和94.64%；MSCT联合CHA2DS2-VASc评分诊断左心房血栓的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为90.91%、93.75%、93.33%、71.43%和98.36%，较MSCT单独诊断有所提高，但差异无统计学意义（P>0.05）；左心房血栓患者左心房前后径和左右径高于无左心房血栓患者（P < 0.05），而左心房射血分数低于无左心房血栓患者（P < 0.05）。 结论MSCT联合CHA2DS2-VASc评分诊断左心房血栓有较好的价值。与MSCT相比较，TEE具有无辐射、可以短时间多次检查和经济实惠等优势。 -
关键词:
- 多层螺旋CT /
- CHA2DS2-VASc评分 /
- 左心房血栓 /
- 诊断价值
Abstract:ObjectiveTo explore the clinical value of Multi slice spiral CT and transesophageal echocardiography in diagnosis of left atrial thrombus. MethodsA total of 150 patients with atrial fibrillation treated in our hospital from January 2019 to may 2020 were examined by MSCT and transesophageal echocardiography (TEE). The value of MSCT in the diagnosis of left atrial thrombosis was analyzed. ResultsThere were 22 cases with left atrial thrombosis, the incidence rate was 14.67%. The proportion of hypertension in patients with left atrial thrombosis was higher than that in patients without left atrial thrombosis (P < 0.05). There were no significant differences of gender, age, type and diabetes between patients with and without left atrial thrombosis (P>0.05). The kappa value of MSCT diagnosis and TEE results was 0.617 (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT in diagnosing left atrial thrombosis were 77.27%, 91.41%, 89.33%, 60.71% and 95.90%. The proportion of CHA2DS2-VASc score≥2 in patients with left atrial thrombosis was significantly higher than that of patients without left atrial thrombosis (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CHA2DS2-VASc score≥2 in the diagnosis of left atrial thrombosis were 72.73%, 82.81%, 81.33%, 40.00% and 94.64%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT combined with CHA2DS2-VASc score in the diagnosis of left atrial thrombosis were 90.91%, 93.75%, 93.33%, 71.43% and 98.36%, which were higher than those of MSCT alone, but the difference was not significant (P>0.05). The anteroposterior diameter and left-right diameter of left atrium in patients with left atrial thrombosis were significantly higher than those in patients without left atrial thrombosis (P < 0.05). The left atrial ejection fraction was significantly lower than that in patients without left atrial thrombosis (P < 0.05). ConclusionMSCT combined CHA2DS2-VASc score has good value in the diagnosis of left atrial thrombosis. Compared with MSCT, it has the advantages of no radiation, can be examined many times in a short time and is economical. -
Key words:
- multi slice spiral CT /
- CHA2DS2-VASc /
- left atrial thrombosis /
- diagnostic value
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图 2 部分患者超声影像图
患者女, 56岁, 阵法性房颤, 超声心电图提示左房血栓.
Figure 2. Ultrasonic images of some patients.
表 1 有、无左心房血栓患者一般资料比较
Table 1. Comparison of general data of patients with and without left atrial thrombosis [n(%)]
组别 男/女（n） 年龄（岁, Mean±SD） 类型 高血压 糖尿病 阵发性房颤 持续性房颤 左心房血栓(n=22) 13/9 53.03±9.36 14（63.64） 8（36.36） 18（81.82） 9（40.91） 无左心房血栓(n=128) 82/46 53.69±10.11 98（76.56） 30（23.44） 66（51.56） 46（35.94） t 0.200 -0.286 1.658 6.975 0.200 P 0.655 0.775 0.198 0.008 0.655 
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表 2 MSCT诊断左心房血栓结果
Table 2. Results of MSCT in diagnosis of left atrial thrombosis
MSCT TEE Kappa P 有 无 有 17 11 0.617 0.000 无 5 117 MSCT: 多层螺旋CT; TEE: 经食管超声心动图.
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表 3 MSCT联合CHA2DS2-VASc评分诊断价值
Table 3. Diagnostic value of MSCT combined with CHA2DS2-VASc score (%)
检查 灵敏性 特异性 准确性 阳性预测值 阴性预测值 MSCT 77.27（17/22） 91.41（117/128） 89.33（134/150） 60.71（17/28） 95.90（117/122） MSCT联合CHA2DS2-VASc评分 90.91（20/22） 93.75（120/128） 93.33（140/150） 71.43（20/28） 98.36（120/122） χ2 -* 0.512 1.516 0.717 0.588 P 0.412 0.474 0.218 0.397 0.443 *采用Fisher精确检验.
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表 4 有、无左心房血栓患者左心房前后径、左右径及LAEF比较
Table 4. Comparison of left atrial anteroposterior diameter, left and right diameter and LAEF in patients with and without left atrial thrombosis (Mean±SD)
组别 左心房前后径（mm） 左心房左右径（mm） LAEF（%） 左心房血栓(n=22) 45.52±9.04 42.11±8.13 29.89±3.41 无左心房血栓(n=128) 33.55±8.92 34.50±9.80 33.82±3.03 t 5.803 3.442 -5.516 P 0.000 0.001 0.000 LAEF: 左心房射血分数.
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