Multidetector computed tomography for the detection of left atrial appendage thrombus: A comparative study with transesophageal echocardiography

Michael Shapiro, Tomas G. Neilan, Davinder S. Jassal, Bharat Samy, Khurram Nasir, Udo Hoffmann, Ammar Sarwar, Javed Butler, Thomas J. Brady, Ricardo C. Cury

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)905-909
Number of pages5
JournalJournal of Computer Assisted Tomography
Volume31
Issue number6
DOIs
StatePublished - Nov 2007
Externally publishedYes

Fingerprint

Atrial Appendage
Multidetector Computed Tomography
Transesophageal Echocardiography
Thrombosis

Keywords

  • Left atrial appendage
  • Multidetector computed tomography
  • Thrombus
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Multidetector computed tomography for the detection of left atrial appendage thrombus : A comparative study with transesophageal echocardiography. / Shapiro, Michael; Neilan, Tomas G.; Jassal, Davinder S.; Samy, Bharat; Nasir, Khurram; Hoffmann, Udo; Sarwar, Ammar; Butler, Javed; Brady, Thomas J.; Cury, Ricardo C.

In: Journal of Computer Assisted Tomography, Vol. 31, No. 6, 11.2007, p. 905-909.

Research output: Contribution to journalArticle

Shapiro, Michael ; Neilan, Tomas G. ; Jassal, Davinder S. ; Samy, Bharat ; Nasir, Khurram ; Hoffmann, Udo ; Sarwar, Ammar ; Butler, Javed ; Brady, Thomas J. ; Cury, Ricardo C. / Multidetector computed tomography for the detection of left atrial appendage thrombus : A comparative study with transesophageal echocardiography. In: Journal of Computer Assisted Tomography. 2007 ; Vol. 31, No. 6. pp. 905-909.
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abstract = "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.",
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AU - Jassal, Davinder S.

AU - Samy, Bharat

AU - Nasir, Khurram

AU - Hoffmann, Udo

AU - Sarwar, Ammar

AU - Butler, Javed

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N2 - 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.

AB - 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.

KW - Left atrial appendage

KW - Multidetector computed tomography

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KW - Transesophageal echocardiography

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