Split-Bolus Single-Phase Cardiac Multidetector Computed Tomography for Reliable Detection of Left Atrial Thrombus: Comparison to Transesophageal Echocardiography

Abstract

Ziel: Evaluierung eines neuen Kardio-MDCT-Protokoll mit Doppel-Bolus-Injektion zur Verbesserung der Detektion von LA-oder LAA-Thromben und Reduzierung falsch positiver Befunde im Vergleich zu den Ergebnissen der transösophagealen Echokardiografie (TEE). Purpose: 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. Materials and 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. Conclusion: MDCT was 100 % accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.

Can Contrast-Enhanced Multi-Detector Computed Tomography Replace Transesophageal Echocardiography for the Detection of Thrombogenic Milieu and Thrombi in the Left Atrial Appendage: A Prospective Study with 124 Patients

“…In a study by Shapiro et al, the sensitivity changed from 80 % to 70 %, the specificity from 73 % to 82 %, the PPV from 54 % to 47 % and the NPV from 90 % to 92 % [19]. However, other studies reported an additional diagnostic benefit from the use of relative HU ratios for the detection of thrombi [20,21]. Possible reasons for the difference in the influence of relative HU ratios on the diagnostic accuracy of MD-CT are the heart rate and rhythm at the time of MD-CT (sinus rhythm vs. atrial fibrillation), the type of scan triggering (fixed time interval vs. bolus tracking), the type of contrast media injection (e. g. monophasic, biphasic), use of ECG gating [17,22], and the number of detector rows [23].…”

The improvement of cardiac multispiral computed tomography protocol for planning interventional arrhythmia management

“…In all studies, almost 100% values of sensitivity, specificity, positive and negative predictive values for imaging of thrombotic masses were obtained. However, the impact of this contrast enhancement technique on the imaging quality of right chambers has not been assessed [27].…”