CT双期增强扫描用于心房颤动患者左心耳血栓诊断的临床观察

  目的  观察CT双期增强扫描检查用于诊断心房颤动(AF)患者左心耳血栓的临床效果。  方法  选择2019年4月—2022年4月黔南州布依族苗族自治州人民医院收治的350例AF患者为研究对象。所有患者均进行经食管超声心动图(TEE)、实时三维经胸超声(RT-3DTTE)和CT双期增强扫描检查，以TEE检查结果为金标准，评价RT-3DTTE和CT双期增强扫描检查对心房颤动患者左心耳血栓的诊断效能；并比较心耳血栓患者与非心耳血栓患者左心房结构指标差异情况。  结果  经TEE检查，心房颤动患者左心耳血栓检出率为12.29%(43/350)。CT双期增强扫描对心房颤动患者左心耳血栓的诊断灵敏度、特异性、准确度、阳性预测值、阴性预测值为97.67%、98.70%、98.57%、91.30%、99.67%，RT-3DTTE分别为79.08%、87.30%、86.28%、46.57%、96.75%，CT双期增强扫描对AF患者左心耳血栓诊断的灵敏度、特异性、准确度、阳性预测值、阴性预测值均显著高于RT-3DTTE(χ2=7.242，P=0.007；χ2=30.634，P＜0.001；χ2=37.745，P＜0.001；χ2=24.464，P＜0.001；χ2=5.682，P=0.017)。CT双期增强扫描对AF患者左心耳血栓诊断的ROC曲线下面积(0.955)高于RT-3DTTE(0.717)；经CT双期增强扫描确诊左心耳血栓患者左心房前后径、左心房横径和左心房上下径检测数值均显著高于非左心耳血栓患者(均P＜0.05)。  结论  CT双期增强扫描对于心房颤动患者左心耳血栓的诊断能力可媲美TEE检查，操作更为简便，无创伤，具有较高的临床应用价值。 

Study on the clinical effect of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation

  Objective  To observe the clinical effect of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation (AF).  Methods  Three hundred and fifty AF patients admitted to the People' s Hospital of Buyi and Miao Autonomous Prefecture of Qiannan Prefecture from April 2019 to April 2022 were selected as the study objects. All patients underwent transesophageal echocardiography (TEE), real-time three-dimensional transthoracic echocardiography (RT-3DTTE) and dual phase enhanced CT scanning. Taking the results of TEE as the gold standard, the diagnostic efficacy of RT-3DTTE and dual phase enhanced CT scanning were evaluated. The differences of left atrial structural indexes between patients with auricular thrombosis and patients without auricular thrombosis were compared.  Results  The detection rate of left atrial appendage thrombosis in patients with AF was 12.29%(43/350) using TEE examination. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with AF (97.67%, 98.70%, 98.57%, 91.30%, 99.67%) were significantly higher than those of RT-3DTTE (79.08%, 87.30%, 86.28%, 46.57% and 96.75%; χ2=7.242, P=0.007; χ2=30.634, P < 0.001; χ2=37.745, P < 0.001; χ2=24.464, P < 0.001; χ2=5.682, P=0.017). The area under ROC curve (0.955) of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with AF was higher than that of RT-3DTTE (0.717). The detection values of left atrial anterior posterior diameter, left atrial transverse diameter and left atrial upper and lower diameter in patients with left atrial appendage thrombosis diagnosed by dual phase enhanced CT scanning were significantly higher than those in patients without left atrial appendage thrombosis (all P < 0.05).  Conclusion  The diagnostic ability of dual phase enhanced CT scanning for left atrial appendage thrombosis in patients with AF is comparable to TEE, but the operation is simpler, non-invasive and has high clinical value.