title: Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus: comparison to transesophageal echocardiography.
abstract: OBJECTIVE
  Evaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent.
  
  
  METHODS
  A total of 182 consecutive patients with drug refractory AF scheduled for PVI (62.6 % male, mean age: 64.1 ± 10.2 years) underwent routine diagnostic work including TEE and cardiac MDCT for the evaluation of LA/LAA anatomy and thrombus formation between November 2010 and March 2012. Contrast media injection was split into a pre-bolus of 30 ml and main bolus of 70 ml iodinated contrast agent separated by a short time delay.
  
  
  RESULTS
  In this study, split-bolus cardiac MDCT identified 14 of 182 patients with filling defects of the LA/LAA. In all of these 14 patients, abnormalities were found in TEE. All 5 of the 14 patients with thrombus formation in cardiac MDCT were confirmed by TEE.
  
  
  CONCLUSIONS
  MDCT was 100 % accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.
  
  
  CONCLUSIONS
  • Patients with no filling defect or thrombus in MDCT in the LA/LAA region are unlikely to have thrombus and may undergo PVI without TEE.• Here, the role of an additional TEE in pre-procedural management prior to PVI in patients with AF has to be redefined.• Using a split-bolus injection protocol increases the diagnostic accuracy of thrombus in the LA/LAA region.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: W
authors.initials: W
authors.lastname: Staab
authors.affiliation: Dept. of Cardiology and Pneumology, Georg-August-University Goettingen, Germany, Goettingen.
authors.forename: C
authors.initials: C
authors.lastname: Sohns
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: P A
authors.initials: PA
authors.lastname: Zwaka
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: J M
authors.initials: JM
authors.lastname: Sohns
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: A
authors.initials: A
authors.lastname: Schwarz
authors.affiliation: Dept. of Medical Statistics, Georg-August-University Goettingen.
authors.forename: S
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Dept. of Cardiology and Pneumology, Georg-August-University Goettingen, Germany, Goettingen.
authors.forename: D
authors.initials: D
authors.lastname: Vollmann
authors.affiliation: Dept. of Cardiology and Pneumology, Georg-August-University Goettingen, Germany, Goettingen.
authors.forename: M
authors.initials: M
authors.lastname: Zabel
authors.affiliation: Dept. of Cardiology and Pneumology, Georg-August-University Goettingen, Germany, Goettingen.
authors.forename: G
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center of Georg-August-University, Goettingen.
authors.forename: J
authors.initials: J
authors.lastname: Lotz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D017115:Catheter Ablation; D003287:Contrast Media / Q000008:administration & dosage*; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011667:Pulmonary Veins / Q000601:surgery; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol