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Cardiac MRI for detecting left atrial/left atrial appendage thrombus in patients with atrial fibrillation

Meta-analysis and systematic review
  • J. Chen
  • H. Zhang
  • D. Zhu
  • Y. Wang
  • S. Byanju
  • M. LiaoEmail author
Review articles

Abstract

Background

The aim of this meta-analysis was to evaluate the accuracy of cardiac magnetic resonance (CMR) in detecting left atrial/left atrial appendage (LA/LAA) thrombus and to analyze the difference between the diagnostic accuracy of various imaging sequences.

Methods

PubMed, Web of Science, Embase, and the Cochrane Library were systematically searched for studies from 2000 to 2017 that compared CMR with transesophageal echocardiography (TEE) in detecting LA/LAA thrombus. The CMR images were analyzed in four categories: (1) cine-CMR; (2) first-pass contrast-enhanced 3D CMR angiography (CE-MRA); (3) delayed-enhancement CMR (DE-CMR); and (4) CMR, regardless of the magnetic resonance sequences used. Descriptive and quantitative information was extracted and Meta-DiSc 1.4 was used to perform the analysis.

Results

The analysis included 582 patients from seven publications. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic of cine-CMR were 91.00%, 93.00%, 50.43, 10.04, 0.24, and 93.93%, respectively; for CE-MRA, the values were 77.00%, 97.00%, 179.21, 51.77, 0.30, and 97.63%, respectively; for DE-CMR, 100.00%, 99.00%, 849.70, 77.62, 0.09, and 99.38%, respectively; and for CMR, 80.00%, 99.00%, 187.54, 24.21, 0.17, and 97.71%, respectively.

Conclusion

In patients with atrial fibrillation, CMR has been proven to be a favorable diagnostic technique for the detection and assessment of LA/LAA thrombus. Among the imaging sequences evaluated, DE-CMR had the highest sensitivity, specificity, and diagnostic accuracy.

Keywords

Cardiac magnetic resonance imaging Left atrium Atrial appendage Thrombosis Arrhythmia 

Abbreviations

AF

Atrial fibrillation

CCT

Cardiac computed tomography

CE-MRA

Contrast-enhanced magnetic resonance angiography

CHA2DS2-VASc

Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, age 65–74 years, sex category

CMR

Cardiac magnetic resonance imaging

DE-CMR

Equilibrium phase delayed enhancement CMR

HAS-BLED

Hypertension, abnormal renal function or abnormal liver function, stroke, bleeding, labile INR, elderly, prior alcohol or drug usage history or medication usage predisposing to bleeding

LA/LAA

Left atrial/left atrial appendage

MRI

Magnetic resonance imaging

PV

Pulmonary veins

TEE

Transesophageal echocardiography

Kardiale MRT zur Erkennung eines Thrombus im linken Vorhof/Herzohr bei Patienten mit Vorhofflimmern

Metaanalyse und systematische Übersicht

Zusammenfassung

Hintergrund

Ziel der vorliegenden Metaanalyse war es, die Genauigkeit der kardialen Magnetresonanztomographie (CMR) bei der Diagnose eines Thrombus im linken Vorhof (linkes Atrium, LA) oder im linken Herzohr („left atrial appendage“, LAA) zu untersuchen und den Unterschied zwischen der diagnostischen Genauigkeit verschiedener Bildgebungssequenzen zu ermitteln.

Methoden

Die Datenbanken PubMed, Web of Science, Embase und die Cochrane Library wurden systematisch nach Studien von 2000 bis 2017 durchsucht, in denen die CMR mit der transösophagealen Echokardiographie (TEE) bei der Erkennung eines LA-/LAA-Thrombus verglichen wurde. Die CMR-Aufnahmen wurden in 4 Kategorien ausgewertet: (1) Cine-CMR, (2) kontrastmittelverstärkte 3‑D-CMR-First-Pass-Angiographie (CE-MRA), (3) CMR mit verzögerter Kontrastverstärkung („delayed enhancement CMR“, DE-CMR) und (4) CMR, unabhängig von den verwendeten MR-Sequenzen. Daraus wurden Informationen zur Beschreibung und quantitativen Erfassung erhoben; die Auswertung erfolgte mit dem Programm Meta-DiSc 1.4.

Ergebnisse

In die Auswertung wurden 582 Patienten aus 7 Publikationen einbezogen. Die gepoolte Sensitivität, Spezifität, diagnostische Odds Ratio, der positive Wahrscheinlichkeitsquotient, der negative Wahrscheinlichkeitsquotient und der summarische Receiver-Operating-Characteristic-Wert der Cine-CMR betrugen 91,00 %; 93,00 %; 50,43; 10,04; 0,24 bzw. 93,93 %; für die CE-MRA lagen die Werte bei 77,00 %; 97,00 %; 179,21; 51,77; 0,30 bzw. 97,63 %; für die DE-CMR bei 100,00 %; 99,00 %; 849,70; 77,62; 0,09 bzw. 99,38 %, und bei der CMR betrugen die Werte 80,00 %; 99,00 %; 187,54; 24,21; 0,17 bzw. 97,71 %.

Schlussfolgerung

Bei Patienten mit Vorhofflimmern hat sich die CMR als vorteilhaftes diagnostisches Verfahren zur Erkennung und Beurteilung eines LA-/LAA-Thrombus erwiesen. Von den untersuchten Bildgebungssequenzen wies die DE-CMR die höchste Sensitivität, Spezifität und diagnostische Genauigkeit auf.

Schlüsselwörter

Kardiale Magnetresonanztomographie Linker Vorhof Herzohr Thrombose Arrhythmie 

Notes

Author contributions.

All authors approved the final version of the manuscript. M. Liao and J. Chen were involved in the conception and design of the review; J. Chen, H. Zhang, D. Zhu, Y. Wang, and S. Byanju were involved in the acquisition, analysis, and interpretation of the data.

Compliance with ethical guidelines

Conflict of interest

J. Chen, H. Zhang, D. Zhu, Y. Wang, S. Byanju, and M. Liao declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

59_2017_4676_MOESM1_ESM.docx (15 kb)
Supplementary Table 1 Study results. SEN sensitivity, SPE specificity, FN false negative, FP false positive, TN true negative, TP true positive

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology, ZhongNan HospitalWuHan UniversityWuhan CityChina

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