Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus: Comparison to transesophageal echocardiography

Abstract

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 30ml and main bolus of 70ml 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. Key Points: •Patients with no filling defect or thrombus in MDCT in the LA/LAA region are unlikely to have thrombus and may undergo PVI without TEE. •Here, the role of an additional TEE in pre-procedural management prior to PVI in patients with AF has to be redefined. •Using a split-bolus injection protocol increases the diagnostic accuracy of thrombus in the LA/LAA region. Citation Format: •Staab W, Sohns C, Zwaka PA etal. Split-Bolus Single-Phase Cardiac Multidetector Computed Tomography for Reliable Detection of Left Atrial Thrombus: Comparison to Transesophageal Echocardiography. Fortschr Röntgenstr 2014; 186: 1009-1015.