Multidetector computed tomography for the detection of left atrial appendage thrombus: a comparative study with transesophageal echocardiography.
OBJECTIVE
To determine the diagnostic performance of multidetector computed tomography (MDCT) for the detection of left atrial appendage (LAA) thrombus as compared with transesophageal echocardiography.


METHODS
Multidetector computed tomography was evaluated in 43 patients qualitatively for the presence or absence of a filling defect in the LAA and compared with transesophageal echocardiography. Additionally, a ratio of the mean computed tomographic attenuation in the LAA apex to the mean computed tomographic attenuation in the aortic root was used for quantitative evaluation.


RESULTS
A filling defect visualized in the LAA by MDCT corresponded to a sensitivity of 70% (7/10), a specificity of 82% (27/33), and a negative predictive value of 90% (27/30) for detection of LAA thrombus. When using quantitative parameters, MDCT demonstrated a sensitivity of 80% (8/10), a specificity of 73% (24/33), and a negative predictive value of 92% (24/26). Multidetector computed tomography was not able to differentiate LAA thrombus from spontaneous echo contrast by either visual evaluation or by quantitative parameters.


CONCLUSIONS
Multidetector computed tomography remains limited for the detection of LAA thrombus. However, a subgroup of patients at very high risk for LAA thrombus may benefit from the high negative predictive value of cardiac MDCT.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Michael D
MD
Shapiro
Tomas G
TG
Neilan
Davinder S
DS
Jassal
Bharat
B
Samy
Khurram
K
Nasir
Udo
U
Hoffmann
Ammar
A
Sarwar
Javed
J
Butler
Thomas J
TJ
Brady
Ricardo C
RC
Cury
D001011:Aorta / Q000000981:diagnostic imaging; D001027:Aortography / Q000379:methods; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D003287:Contrast Media; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013927:Thrombosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol