Skip to main content

The optimal cardiac phase for detecting the thrombi of the left atrial appendage on multi-slice computed tomography in patients with atrial fibrillation

Abstract

We evaluated patients with atrial fibrillation (Af) to define the optimal phase for ECG-gated image reconstruction for multi-slice CT (MSCT) of the left atrial appendage (LAA). We performed MSCT scans in 37 patients with Af, and we reconstructed multi-planar reformation images of the LAA, defined by the absolute delay (ms) immediately after the T wave, and by the relative delay (%). For visual analysis of the image quality for each image, a four-grade scoring system (poor to excellent) was used by two blinded, independent reviewers. Images obtained by absolute delay and by relative delay were classified as being of poor, fair, good, or excellent quality in 2, 2, 8, and 25 cases, and in 18, 11, 8, and 0 cases, respectively. This phase-definition strategy in Af patients is more effective by absolute delay than by relative delay, and MSCT could provide an alternative diagnostic assessment of LAA thrombi.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155(5):469–73.

    Article  CAS  PubMed  Google Scholar 

  2. Martin D. Atrial fibrillation. Oxford: Blackwell; 1994.

    Google Scholar 

  3. de Divitiis M, Omran H, Rabahieh R, Rang B, Illien S, Schimpf R, et al. Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors. Am J Cardiol. 1999;84(9):1023–8.

    Article  PubMed  Google Scholar 

  4. Schweizer P, Bardos P, Erbel R, Meyer J, Merx W, Messmer BJ, et al. Detection of left atrial thrombi by echocardiography. Br Heart J. 1981;45(2):148–56.

    Article  CAS  PubMed  Google Scholar 

  5. Shrestha NK, Moreno FL, Narciso FV, Torres L, Calleja HB. Two-dimensional echocardiographic diagnosis of left-atrial thrombus in rheumatic heart disease. A clinicopathologic study. Circulation. 1983;67(2):341–7.

    CAS  PubMed  Google Scholar 

  6. Matsumura M, Wong M, Omoto R. Assessment of Doppler color flow mapping in quantification of aortic regurgitation—correlations and influencing factors. Jpn Circ J. 1989;53(7):735–46.

    CAS  PubMed  Google Scholar 

  7. Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, et al. Safety of transesophageal echocardiography. A multicenter survey of 10, 419 examinations. Circulation. 1991;83(3):817–21.

    CAS  PubMed  Google Scholar 

  8. Kitayama H, Kiuchi K, Endo T, Hayakawa H. Value of cardiac ultrafast computed tomography for detecting right atrial thrombi in chronic atrial fibrillation. Am J Cardiol. 1997;79(9):1292–5.

    Article  CAS  PubMed  Google Scholar 

  9. Hong C, Becker CR, Huber A, Schoepf UJ, Ohnesorge B, Knez A, et al. ECG-gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on image quality. Radiology. 2001;220(3):712–7.

    Article  CAS  PubMed  Google Scholar 

  10. Matsuo S, Nakamura Y, Matsumoto T, Nakae I, Nagatani Y, Takazakura R, et al. Visual assessment of coronary artery stenosis with electrocardiographcally gated multislice computed tomography. Int J Cardiovasc Imaging. 2004;20:61–6.

    Article  PubMed  Google Scholar 

  11. Kopp AF, Schroeder S, Kuettner A, Heuschmid M, Georg C, Ohnesorge B, et al. Coronary arteries: retrospectively ECG-gated multi-detector row CT angiography with selective optimization of the image reconstruction window. Radiology. 2001;221(3):683–8.

    Article  CAS  PubMed  Google Scholar 

  12. Vembar M, Garcia MJ, Heuscher DJ, Haberl R, Matthews D, Böhme GE, et al. A dynamic approach to identifying desired physiological phases for cardiac imaging using multislice spiral CT. Med Phys. 2003;30(7):1683–93.

    Article  CAS  PubMed  Google Scholar 

  13. Sato Y, Kanmatsuse K, Inoue F, Horie T, Kato M, Kusama J, et al. Noninvasive coronary artery imaging by multislice spiral computed tomography. Circ J. 2003;67(2):107–11.

    Article  PubMed  Google Scholar 

  14. Sato Y, Matsumoto N, Kato M, Inoue F, Horie T, Kusama J, et al. Noninvasive assessment of coronary artery disease by multislice spiral computed tomography using a new retrospectively ECG-gated image reconstruction technique. Circ J. 2003;67(5):401–5.

    Article  PubMed  Google Scholar 

  15. Gottlieb I, Pinheiro A, Brinker JA, Corretti MC, Mayer SA, Bluemke DA, et al. Diagnostic accuracy of arterial phase 64-slice multidetector CT angiography for left atrial appendage thrombus in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2008;19(3):247–51.

    Article  PubMed  Google Scholar 

  16. Tang RB, Dong JZ, Zhang ZQ, Li ZA, Liu XP, Kang JP, et al. Comparison of contrast enhanced 64-slice computed tomography and transesophageal echocardiography in detection of left atrial thrombus in patients with atrial fibrillation. J Interv Card Electrophysiol. 2008;22(3):199–203.

    Article  PubMed  Google Scholar 

  17. Saremi F, Channual S, Gurudevan SV, Narula J, Abolhoda A. Prevalence of left atrial appendage pseudothrombus filling defects in patients with atrial fibrillation undergoing coronary computed tomography angiography. J Cardiovasc Comput Tomogr. 2008;2(3):164–71.

    Article  PubMed  Google Scholar 

  18. IEC 60601-2-44: particular requirements for the safety of X-ray equipment for computed tomography, part 2-44, Switzerland; 2002.

  19. Ohnesorge B, Flohr T, Becker CR, Kopp AF, Schoepf UJ, Baum U, et al. Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology. 2000;217:564–71.

    CAS  PubMed  Google Scholar 

  20. Henry JP, Meehan JP. The circulation: an integrative physiology study, Year Book Medical Publishers; 1971.

  21. Anno H, Kakizawa S, Kondo T, Anami K, Katada K, Ota T. Effectiveness of the ECG-gated segmental reconstruction method in 0.4-rot: MSCT for high resolution CT coronary angiography. RSNA Scientific Assembly and Annual Meeting Program; 2003. p. 767.

  22. Motoyama S, Anno H, Sarai M, Sato T, Sanda Y, Ozaki Y, et al. Noninvasive coronary angiography with a prototype 256-row area detector computed tomography system: comparison with conventional invasive coronary angiography. J Am Coll Cardiol. 2008;51(7):773–5.

    Article  PubMed  Google Scholar 

  23. Rybicki FJ, Otero HJ, Steigner ML, Vorobiof G, Nallamshetty L, Mitsouras D, et al. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging. 2008;24(5):535–46.

    Article  PubMed  Google Scholar 

  24. Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004;363(9406):345–51.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Muneo Ohba.

About this article

Cite this article

Monzen, H., Shimoyama, H., Hirata, M. et al. The optimal cardiac phase for detecting the thrombi of the left atrial appendage on multi-slice computed tomography in patients with atrial fibrillation. Radiol Phys Technol 3, 78–83 (2010). https://doi.org/10.1007/s12194-009-0080-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12194-009-0080-3

Keywords

  • Multi-slice CT
  • Atrial fibrillation
  • Left atrial appendage
  • Reconstruction
  • Cardiac phase