| 1. Weiss S, Buhlmann R, von Allmen RS, et al. Management of floating thrombus in the aortic arch. Journal of Thoracic & Cardiovascular Surgery. 152(3):810-7, 2016 09. |
Observational-Tx |
10 patients |
To assess detailed narrative data including risk factors, clinical presentation, treatment modality, and midterm outcome of patients with floating aortic arch thrombus. |
Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). |
3 |
| 2. Kumagai T, Matsuura Y, Yamamoto T, Ugawa Y, Fukushima T. Risk factors for left atrial thrombus from transesophageal echocardiography findings in ischemic stroke patients. Fukushima J Med Sci. 60(2):154-8, 2014. |
Observational-Dx |
98 patients |
To analyze TEE findings and investigated factors associated with left atrial thrombus (LAT) detected by TEE. |
LAT was detected with TEE in 20 patients (20%). The factors that were significantly associated with the presence of LAT were male sex (unadjusted odds ratio (OR), 3.94; 95% confidence interval (CI), 1.07-14.58; p=0.037), presence of AF (unadjusted OR, 9.58; 95% CI, 2.58-35.50; p< 0.001), SEC (unadjusted OR, 8.48; 95% CI, 2.57-28.00; p< 0.001) and LAA slow flow velocity (unadjusted OR, 5.18; 95% CI, 1.59-16.91; p=0.005). Multivariate logistic regression analysis revealed that male sex (adjusted OR, 5.30; 95% CI, 1.09-25.71; p=0.039), presence of AF (adjusted OR, 8.97; 95% CI, 1.10-73.20; p=0.041) and SEC (adjusted OR, 10.87; 95% CI, 1.001-118.0; p=0.049) were independently associated with LAT, but LAA slow flow velocity was not. |
3 |
| 3. Wysokinski WE, Ammash N, Sobande F, Kalsi H, Hodge D, McBane RD. Predicting left atrial thrombi in atrial fibrillation. Am Heart J. 159(4):665-71, 2010 Apr. |
Observational-Dx |
110 cases, 387 controls |
To determine whether CHADS(2) score is predictive of left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). |
The CHADS(2) score was significantly higher for cases (n = 110, mean +/- SD 2.8 +/- 1.6) compared to controls (n = 387, 1.6 +/- 1.3). By multivariate analysis, independent predictors of LAAT included heart failure (HR 5.78, P < 0001), prior stroke/transient ischemic attack (HR 3.94, P < .0001), diabetes mellitus (HR 1.98, P = .015), permanent AF (HR 3.02, P < .05), AF duration (HR 2.24, P < .05), and spontaneous echocardiographic contrast (HR 4.35, P = .005). Using these elements, a new scoring system provided cleaner case-control separation (C-index 0.90) and higher predictive power compared to CHADS(2) (C-index 0.71). |
1 |
| 4. Yamamoto M, Seo Y, Kawamatsu N, et al. Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation. Circ Cardiovasc Imaging. 7(2):337-43, 2014 Mar. |
Observational-Dx |
564 patients |
To clarify the relation between LAA morphology evaluated with 3D-TEE and LAA thrombus in patients with AF in comparison with conventional indices. |
We prospectively enrolled 633 consecutive patients who were candidates for catheter ablation for symptomatic drug-resistant AF. Transesophageal echocardiography (TEE) was performed to assess LAA thrombus. LAA structure was assessed by 3-dimensional TEE. LAA orifice area, depth, volume, and number of lobes were measured on reconstructed 3-dimensional images. Clinical characteristics and echocardiographic measures were compared to determine variables predicting LAA thrombus. Excluded were 69 (10.9%) patients who met the exclusion criteria. Finally, this study comprised 564 patients, of whom LAA thrombus was observed in 36 (6.4%) patients. Multivariate analysis revealed CHADS2 (Congestive heart failure, Hypertension Age>75, Diabetes mellitus and prior Stroke or transient ischemic attack) score (P=0.002), left ventricular ejection fraction (P=0.01), degree of spontaneous echo contrast (P=0.02), left atrial volume (P=0.02), and number of LAA lobes (P<0.001) to be independently associated with thrombus formation. Most patients with LAA thrombus (32/34, 94.4%) had =3 LAA lobes, whereas LAA thrombus was observed in only 2 (0.7%) of 296 patients with 1 or 2 lobes. LAA volume significantly decreased in patients maintaining sinus rhythm after catheter ablation (P=0.0009). Number of LAA lobes did not change in any patient. |
3 |
| 5. Gianstefani S, Douiri A, Delithanasis I, et al. Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention. Am J Cardiol 2014;113:1111-6. |
Observational-Dx |
1,059 patients with ST-elevation myocardial infarction (STEMI) |
To define the incidence of left ventricular thrombus (LVT) and its predictors in the contemporary era of primary percutaneous intervention (pPCI) and contrast echocardiography. |
LVT was detected in 42 subjects (4%). There were no significant differences in baseline demographics or pre-PCI clinical features between the 2 groups. Post-treatment, mean ejection fraction (EF) in patients with LVT was 35±8.4% and in those without LVT was 47±10%, p<0.001. Thirty-seven patients (88%) in the LVT group presented with an anterior STEMI versus 471 patients (42%) in the without LVT group (p<0.001). Apical akinesis was noted in all patients with LVT irrespective of the principal location of the MI. Multivariate analysis predictors of LVT were reduced EF, anterior site of MI, and the use of platelet glycoprotein IIb/IIIa inhibitors. After diagnosis of LVT, patients were treated with warfarin for 3 to 6 months. No significant difference in mortality was detectable at discharge between the 2 groups. |
2 |
| 6. McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL, Jr., Bhatt DL, McEvoy JW. Left Ventricular Thrombus After Acute Myocardial Infarction: Screening, Prevention, and Treatment. JAMA Cardiol 2018;3:642-49. |
Review/Other-Dx |
N/A |
To review the epidemiology, pathogenesis, diagnosis, prevention, and treatment of LV thrombus after acute MI. |
No results available. |
4 |
| 7. Sordelli C, Fele N, Mocerino R, et al. Infective Endocarditis: Echocardiographic Imaging and New Imaging Modalities. J Cardiovasc Echogr 2019;29:149-55. |
Review/Other-Dx |
N/A |
To provide an overview of the imaging techniques useful for the diagnosis and identification of any complications. |
No results available. |
4 |
| 8. Wintersperger BJ, Becker CR, Gulbins H, et al. Tumors of the cardiac valves: imaging findings in magnetic resonance imaging, electron beam computed tomography, and echocardiography. Eur Radiol 2000;10:443-9. |
Review/Other-Dx |
3 patients |
To describe the findings from various cross-sectional imaging modalities in patients with cardiac valve adherent masses. |
All three patients had neurological symptoms and/or cardiac murmurs. Transthoracic and/or transesophageal echocardiography revealed the cardiac mass in all three. For differentiation of thrombus and cardiac neoplasm magnetic resonance imaging (MRI) was also performed in all three patients and electron-beam computed tomography (EBCT) in two. Fast segmented cine gradient-echo MRI techniques provided mass depiction in all patients, while T1-weighted spin-echo imaging failed in mass detection in one patient. None of the patients showed evidence of valve regurgitation or stenosis in flow sensitive cine MRI. EBCT excluded mass calcifications in both patients and reliably demonstrated the valve attached lesions. Although echocardiography is the modality of choice in evaluating cardiac masses and especially valve attached masses, MRI and EBCT provide additional information about tissue characteristics and allows an excellent overview of the cardiac and paracardiac morphology. Fast segmented cine gradient-echo MRI is especially able to depict even small tumors attached to rapidly moving cardiac valves, and valve competence can be easily assessed within the same examination. |
4 |
| 9. O'Connell JB, Quinones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischemia. Semin Vasc Surg 2009;22:10-6. |
Review/Other-Dx |
N/A |
To review the clinical features, angiographic findings, and strategies for management for these similar but distinct etiologies: acute embolic versus thrombotic limb ischemia. |
No results provided. |
4 |
| 10. Yoo SM, Lee HY, White CS. MDCT evaluation of acute aortic syndrome. [Review] [62 refs]. Radiol Clin North Am. 48(1):67-83, 2010 Jan. |
Review/Other-Dx |
N/A |
To provide a summary of acute aortic syndrome (AAS), focusing especially on the multidetector CT technique and findings of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and unstable aortic aneurysm. |
No results available. |
4 |
| 11. Tsilimparis N, Hanack U, Pisimisis G, Yousefi S, Wintzer C, Ruckert RI. Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta--an unusual source of arterial embolism. Eur J Vasc Endovasc Surg. 41(4):450-7, 2011 Apr. |
Review/Other-Dx |
8 patients with mural thrombus |
To report our experience regarding the diagnosis and management of thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta (NAADTA). |
Eight patients with mural thrombus of the NAADTA were identified. Arterial embolism was the main clinical finding in all cases and involved the lower extremities (n = 6), mesenteric (n = 3) or renal arteries (n = 2). Hypercoagulable disorders were present in 3 cases and a concurrent malignancy in another 3. Two patients underwent open surgery while 4 patients were treated conservatively with anticoagulation. Of the remaining 2 patients, one was treated with a thoracic stent-graft and aorto-biiliac bypass and the other one with transfemoral thrombectomy. Technical success was achieved in all surgical cases and thrombus resolution or stable disease in the conservative management group. No thrombus recurrence was observed during a mean follow-up of 49 months. |
4 |
| 12. Klang E, Kerpel A, Soffer S, et al. CT imaging features of symptomatic and asymptomatic floating aortic thrombus. Clin Radiol. 73(3):323.e9-323.e14, 2018 03. |
Observational-Dx |
15 patients total (symptomatic group: 6, asymptomatic group: 9) |
To present the computed tomography (CT) imaging features of floating aortic thrombus with emphasis on clinical and radiographic predictors for systemic shower emboli. |
The symptomatic group included 6/15 (40%) patients and the asymptomatic group included 9/15 (60%) patients. Patients in the symptomatic group were significantly younger (symptomatic: 53.3±11.7 years, asymptomatic: 76.9±8.4 years, p=0.003). All the symptomatic patients were women (100%), while 2/9 (22.2%) of the asymptomatic patients were women, (p=0.007). A non-calcified insertion site was more frequent in the symptomatic group (symptomatic 4/6 [66.7%] versus asymptomatic group 1/9 [11.1%], p=0.011). The percentage of thrombus circumference attached to the aortic wall was significantly smaller in symptomatic patients (symptomatic: 31.8±8.4%, asymptomatic: 43.7±5%, p=0.003). |
2 |
| 13. Pagni S, Trivedi J, Ganzel BL, et al. Thoracic aortic mobile thrombus: is there a role for early surgical intervention?. Ann Thorac Surg. 91(6):1875-81, 2011 Jun. |
Review/Other-Tx |
14 patients with TAMT |
To better define the role of early (less than 2 weeks) surgical thrombectomy. |
All patients were initially treated with heparin and aspirin. Thoracic aortic thrombectomies were performed in 8 patients within 2 weeks of diagnosis: left thoracotomy (n=5), thoracoabdominal (n=1), and median sternotomy (n=2). Left atrial-femoral bypass was used in 5 patients, cardiopulmonary bypass in 2, and no support in 1. Additional procedures were celiac artery (n=1) and left subclavian artery (n=2) thrombectomies. Procedures for embolic complications were performed in 7 patients before aortic thrombectomy. Operative mortality was 0%, with no recurrent embolic events after 24±16 months. One patient had thrombectomy of the ascending aorta and medical therapy with warfarin and aspirin for a second concurrent small thrombus in the descending aorta. One patient presented with multiorgan failure and died shortly after admission. Six patients treated medically were discharged on a regimen of oral warfarin and aspirin (14±11 months follow-up), with 2 fatal recurrent embolic events within 6 weeks (p=0.09). |
4 |
| 14. Boufi M, Mameli A, Compes P, Hartung O, Alimi YS. Elective stent-graft treatment for the management of thoracic aorta mural thrombus. European Journal of Vascular & Endovascular Surgery. 47(4):335-41, 2014 Apr. |
Observational-Tx |
13 patients |
To describe the management of aorta mural thrombus (AMT) in the thoracic aorta with either conservative or stentgraft treatment and to analyze the role of morphological characteristics of thrombus in the selection of suitable candidates for intervention. |
From January 2006 to March 2013, 13 consecutive patients (nine male, mean age 53, range 37e76) wereadmitted for symptomatic (n ¼ 8) or asymptomatic AMT (n ¼ 5). All patients received unfractionated heparin.Management of primary aortic thrombus required stentgraft in seven patients, aortic thrombectomy in one, andanticoagulation therapy alone in five. Indications for intervention were recurrent embolism (n ¼ 4), occurrenceof embolism under heparin (n ¼ 1), or persistent thrombus (n ¼ 2). Endovascular exclusion of AMT wassuccessful in all cases, with no complications or deaths at 30 days and no recurrence at midterm. Analysis of themorphological features of the thrombus identified solely the high degree mobility as associated with adverseoutcome (p ¼ .048). |
2 |
| 15. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 16. Fleischmann D, Mitchell RS, Miller DC. Acute aortic syndromes: new insights from electrocardiographically gated computed tomography. [Review] [8 refs]. Semin Thorac Cardiovasc Surg. 20(4):340-7, 2008. |
Review/Other-Dx |
N/A |
To describe developments of CTA with retrospective electrocardiographic (ECG) gating provides additional benefits because it eliminates cardiac pulsation motion artifacts and has extended the clinical applicability of CTA to also include the aortic root. |
No results in abstract |
4 |
| 17. Holloway BJ, Rosewarne D, Jones RG. Imaging of thoracic aortic disease. [Review]. Br J Radiol. 84 Spec No 3:S338-54, 2011 Dec. |
Review/Other-Dx |
N/A |
To discuss the imaging of the most common disease processes that affect the aorta in adults, with the primary focus being on CT and MRI. |
No results available. |
4 |
| 18. Hur J, Kim YJ, Lee HJ, et al. Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology. 251(3):683-90, 2009 Jun. |
Observational-Dx |
55 consecutive patients |
To assess the diagnostic accuracy of two-phase 64-section cardiac computed tomographic (CT) angiography for detection of left atrial appendage (LAA) thrombi and differentiation between thrombus and circulatory stasis in patients with stroke, with transesophageal echocardiography (TEE) as the reference standard. |
A total of 14 thrombi were detected in the 55 patients at TEE. With TEE as the reference standard, the overall sensitivity, specificity, and positive and negative predictive values of cardiac CT angiography for the detection of thrombus in the LAA were 100% (14 of 14 patients), 98% (40 of 41 patients), 93% (14 of 15 patients), and 100% (40 of 40 patients), respectively. Concordance between cardiac CT angiography and TEE for the detection of thrombus in the LAA was high (overall kappa = 0.953). Mean LAA/AA values were significantly different between thrombus (0.29 HU +/- 0.12 [standard deviation]) and circulatory stasis (0.85 HU +/- 0.12) on late-phase CT images (P < .001). |
1 |
| 19. Hur J, Kim YJ, Lee HJ, et al. Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography. Stroke. 42(9):2471-7, 2011 Sep. |
Observational-Dx |
83 consecutive patients with stroke |
To assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. |
Among the 83 patients, a total of 13 thrombi combined with spontaneous echo contrast and 14 spontaneous echo contrasts were detected by transesophageal echocardiography. All 13 thrombi combined with spontaneous echo contrast were correctly diagnosed on CT. Using transesophageal echocardiography as the reference standard, the overall sensitivity and specificity of CT for the detection of thrombi and circulatory stasis in the left atrial appendage were 96% (95% CI, 78% to 99%), and 100% (95% CI, 92% to 100%), respectively. On CT, the mean left atrial appendage/ascending aorta Hounsfield unit ratios were significantly different between thrombus and circulatory stasis (0.15 Hounsfield unit versus 0.27 Hounsfield unit, P=0.001). The mean effective radiation dose was 3.11 mSv. |
1 |
| 20. Hur J, Kim YJ, Lee HJ, et al. Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis. Radiology. 263(3):688-95, 2012 Jun. |
Observational-Dx |
32 patients with stroke who had atrial fibrillation; 31 patients in control group |
To assess the diagnostic performance of dual-energy cardiac computed tomography (CT) in the detection of left atrial appendage (LAA) thrombi and differentiation between thrombus and circulatory stasis in patients with stroke, by using transesophageal echocardiography (TEE) as the reference standard. |
Among the 63 patients, a total of 13 thrombi and 19 instances of SEC were detected at TEE. Using TEE as the reference standard, the overall sensitivity, specificity, positive predictive value, and negative predictive value of dual-energy cardiac CT in the detection of thrombi and SEC in the LAA were 97% (95% confidence interval [CI]: 82%, 100%), 100% (95% CI: 86%, 100%), 100%, and 97%, respectively. At CT, the mean iodine concentration was 1.23 mg/mL ± 0.34 (standard deviation) for thrombus and 3.61 mg/mL ± 1.01 for SEC (P = .001). |
1 |
| 21. Teunissen C, Habets J, Velthuis BK, Cramer MJ, Loh P. Double-contrast, single-phase computed tomography angiography for ruling out left atrial appendage thrombus prior to atrial fibrillation ablation. Int J Cardiovasc Imaging. 33(1):121-128, 2017 Jan. |
Observational-Dx |
477 patients |
To present results from a double-contrast, single-phase CTA protocol used in our daily clinical practice. |
In patients who underwent AF ablation between 2011 and 2015, double-contrast, single-phase CTA was performed prior to ablation. Two contrast boluses (30 and 70 ml) with 25-s interbolus delay were administered followed by prospectively triggered cardiac CTA. Only patients with left atrial (LA) or LAA filling defects underwent transesophageal echocardiography (TEE) to rule out thrombus. Prior to ablation, 605 CTA-scans were performed (median radiation dose: 3.1 mSv). In 579 CTA-scans (95.7 %), the LA and LAA completely filled with contrast. In 26 CTA-scans (4.3 %) the LAA showed a filling defect whereby thrombus could not be excluded. In 2 of those 26 patients (7.7 % and 0.3 % of the total population), TEE verified LAA thrombus. Low-risk LAA filling defects on CTA (n = 7/26) with an inhomogeneous aspect, Houndsfield Unit values >100, and an indefinite border were all caused by incomplete contrast mixing. No thromboembolic complications occurred perioperatively or during 6 months follow-up. Prior to AF ablation, incidence of LAA filling defects on double-contrast, single-phase CTA is low. TEE remains warranted in all but low-risk filling defects to rule out thrombus. |
2 |
| 22. Kapa S, Martinez MW, Williamson EE, et al. ECG-gated dual-source CT for detection of left atrial appendage thrombus in patients undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol. 29(2):75-81, 2010 Nov. |
Observational-Dx |
255 patients |
To determine the utility of ECG-gated dual-source computed tomography (DSCT) in detecting left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF). |
An under-filled LAA was identified in 33 patients (12.9%), of whom four had thrombus confirmed by TEE. All patients diagnosed with LAA thrombus using TEE also had an abnormal LAA by gated DSCT. Thus, sensitivity and specificity for gated DSCT were 100% and 88%, respectively. No cases of LAA filling defects were observed in patients <51 years old with a CHADS2 of 0. |
2 |
| 23. Zhai Z, Tang M, Zhang S, et al. Transoesophageal echocardiography prior to catheter ablation could be avoided in atrial fibrillation patients with a low risk of stroke and without filling defects in the late-phase MDCT scan: A retrospective analysis of 783 patients. Eur Radiol. 28(5):1835-1843, 2018 May. |
Observational-Dx |
783 patients with AF (Thrombus group n=8, Control group n=775) |
To test whether multidetector computed tomography (MDCT) could completely replace transoesophageal echocardiography (TEE) to detect left atrial appendage (LAA) thrombi in atrial fibrillation (AF) patients using a large sample size. |
Most of the patients (96.2 %) had a CHA2DS2-VASc score (congestive heart failure, hypertension, age = 75 years old (doubled), diabetes, stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65-74 years, female sex) = 3. Eight thrombi were identified by TEE, all of which were detected by MDCT; no thrombus was observed with TEE without the observation of filling defects by late-phase MDCT scanning in any of the patients. Using TEE as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of MDCT for thrombus detection were 100 %, 95.74 % (95 % CI 94.33 %-97.15 %), 19.51 % (95 % CI 16.73 %-22.29 %) and 100 %, respectively. |
2 |
| 24. Ikegami Y, Tanimoto K, Inagawa K, et al. Identification of Left Atrial Appendage Thrombi in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation Using Intra-Cardiac Echocardiography and Cardiac Computed Tomography. Circ J. 82(1):46-52, 2017 12 25. |
Observational-Dx |
108 patients |
To investigate the advantages of additional pre-procedural LA appendage (LAA) thrombus evaluation using ICE and the clinical value of CCT in persistent and long-standing persistent AF. |
We analyzed data from 108 consecutive patients with persistent and long-standing persistent AF who were scheduled to undergo AF ablation. TEE was performed within 24 h prior to ablation. ICE was performed for 97 patients in whom a thrombus was not detected on TEE. CCT was performed in 95 patients. Thrombus or sludge was detected on TEE in 11 patients (10.3%), for whom ablation was cancelled. Four additional patients were diagnosed with LAA thrombus on ICE. When TEE and ICE were used as the reference for thrombus detection, the sensitivity, specificity, positive predictive value, and negative predictive value of CCT for identifying contrast defects in the LAA were 100%, 81.0%, 40.7%, and 100%, respectively. |
2 |
| 25. Kantarci M, Ogul H, Sade R, Aksakal E, Colak A, Tanboga IH. Circulatory Stasis or Thrombus in Left Atrial Appendage, An Easy Diagnostic Solution. J Comput Assist Tomogr. 43(3):406-409, 2019 May/Jun. |
Observational-Dx |
53 patients |
To assess the diagnostic performance of prone position cardiac multidetector computed tomography (MDCT) in the detection of left atrial appendage (LAA) thrombi and to make differentiate between thrombus and circulatory stasis using transesophageal echocardiography (TEE) as the criterion-standard imaging modality. |
For the MDCT scan in the prone position, the sensitivity, specificity, positive predictive value, and negative predictive value results were 100%, 100%, 100%, and 100%, respectively. |
1 |
| 26. Bilchick KC, Mealor A, Gonzalez J, et al. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation. Heart Rhythm. 13(1):12-9, 2016 Jan. |
Review/Other-Dx |
320 AF ablation patients with CTA imaging |
To determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care. |
Among CTA patients with delayed LAA imaging, the sensitivity and negative predictive values for LAA thrombus with intracardiac echocardiography (ICE) or transesophageal echocardiograms (TEEs) as the reference standard were both 100%. ICE during ablation confirmed absence of thrombus in patients with a negative CTA or negative TEE. No patients with either a negative CTA or an equivocal CTA combined with a negative TEE had strokes or transient ischemic attacks. Overall, the need for TEEs decreased from 57.5% to 24.0% during the 3-year period as a result of the CTA protocol. |
4 |
| 27. Martinez MW, Kirsch J, Williamson EE, et al. Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc Imaging 2009;2:69-76. |
Observational-Dx |
402 patients |
To determine whether multidetector computed tomography (MDCT) is able to exclude left atrial appendage (LAA) thrombus in patients referred for catheter ablation of atrial fibrillation (CAAF). |
Four hundred two patients (mean age 56 +/- 10 years; 76% male; ejection fraction 56 +/- 10%) were included. Three hundred sixty-two had no evidence of a filling defect by ungated MDCT or left atrial spontaneous echo contrast or thrombus by TEE. In 40 patients, the LAA was "underfilled" with 9 definite thrombi confirmed by TEE. Sensitivity and specificity was 100% and 92%, respectively, with a negative predictive value of 100% and positive predictive value of 23%. In patients with LAA underfilling, Doppler-derived LAA emptying velocities were substantially reduced (mean 19 cm/s; range 6 to 61 cm/s) below the normal range. A higher CHADS(2) (congestive heart failure, hypertension, age older than 75 years, and diabetes) score (1.6 vs. 1.1) was observed in patients with LAA filling defects. No cases of LAA thrombus were observed in patients age <52 years with CHADS(2) score <1. |
1 |
| 28. Romero J, Husain SA, Kelesidis I, Sanz J, Medina HM, Garcia MJ. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. [Review]. Circ Cardiovasc Imaging. 6(2):185-94, 2013 Mar 01. |
Meta-analysis |
19 studies with 2955 patients |
To evaluate the diagnostic accuracy of cardiac computed tomography assessing left atrial/LA appendage (LA/LAA) thrombi in comparison with transesophageal echocardiogram (TEE) . |
Nineteen studies with 2955 patients (men, 71%; mean age, 61±4 years) fulfilled the inclusion criteria. Most studies (85%, 16 studies) used 64-slide multidetector computed tomography and 15 studies (79%) were electrocardiographic-gated. The incidence of LA/LAA thrombi was 8.9% (SD, ±7). The mean sensitivity and specificity were 96% and 92%, whereas the positive predictive value and negative predictive value were 41% and 99%, respectively. The diagnostic accuracy was 94%. In a subanalysis of studies in which delayed imaging was performed, the diagnostic accuracy significantly improved to a mean weighted sensitivity and specificity of 100% and 99%, respectively, whereas the positive predictive value and negative predictive value increased to 92% and 100%, respectively. The accuracy for this technique was 99%. |
Good |
| 29. Vira T, Pechlivanoglou P, Connelly K, Wijeysundera HC, Roifman I. Cardiac computed tomography and magnetic resonance imaging vs. transoesophageal echocardiography for diagnosing left atrial appendage thrombi. Europace. 21(1):e1-e10, 2019 Jan 01. |
Meta-analysis |
26 studies |
To determine whether expected sensitivity and specificity differed between early and delayed image acquisition protocols for cardiac computed tomography (CCT) vs. transoesophageal echocardiography (TOE) and between cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR). |
Cardiac computed tomography demonstrated sensitivity and specificity of 0.99 [confidence interval (CI 0.93-1.00)] and 0.94 (CI 0.90-0.97) respectively vs. TOE. A subgroup analysis comparing early vs. delayed protocol CCT imaging was performed showing no significant differences in sensitivity (P-value = 0.17) however improved specificity of the delayed imaging protocols (P-value = 0.04). Cardiac magnetic resonance imaging demonstrated sensitivity and specificity of 0.80 (CI 0.63-0.91) and 0.98 (CI 0.97-0.99), respectively when compared to TOE. There was no significant difference in sensitivity or specificity between CMR and CCT (P-values 0.996 and 0.484, respectively). |
Good |
| 30. Zou H, Zhang Y, Tong J, Liu Z. Multidetector computed tomography for detecting left atrial/left atrial appendage thrombus: a meta-analysis. [Review]. Intern Med J. 45(10):1044-53, 2015 Oct. |
Meta-analysis |
15 trials with 2540 patients |
To evaluate synthetically the diagnostic accuracy of multidetector computed tomography (MDCT) in left atrial/left atrial appendage (LA/LAA) thrombus. |
Fifteen prospective clinical controlled trials with 2540 patients fulfilled the inclusion criteria. The pooled sensitivities (SEN): 0.957; pooled specificities (SPE): 0.917; pooled positive likelihood ratio (PLR): 22.017; pooled negative likelihood ratio (NLR): 0.060; pooled diagnostic odds ratio (DOR): 437.43; the area under the curve (AUC): 0.9883; Q*-value: 0.9544. However, in the abovementioned indexes, the heterogeneities were statistically significant between studies (P < 0.05, inconsistency index (I(2) ) > 50%). In a sub-analysis of studies in which delayed imaging, electrocardiogram (ECG) gating and heart rate control were performed, not only the diagnostic accuracy, but also the heterogeneities were significantly improved (pooled SEN 0.991; pooled SPE 0.989; pooled PLR 60.768; pooled NLR 0.034; pooled DOR 2561.7; AUC 0.9972; Q*-value 0.9806; all the indexes' P-value were greater than 0.05 and the I(2) were 0%, except for SPE, I(2) = 54.6%). |
Good |
| 31. Choi BH, Ko SM, Hwang HK, et al. Detection of left atrial thrombus in patients with mitral stenosis and atrial fibrillation: retrospective comparison of two-phase computed tomography, transoesophageal echocardiography and surgical findings. Eur Radiol. 23(11):2944-53, 2013 Nov. |
Observational-Dx |
106 patients with MS and AF |
To assess the accuracy of two-phase computed tomography (CT) and transoesophageal echocardiography (TEE) for the detection of left atrial (LA) thrombus in patients with mitral stenosis (MS) and atrial fibrillation (AF), by using intraoperative findings as the reference standard. |
LA echodense masses on TEE and LA filling defects on two-phase CT were observed in 29 and 39 patients, respectively. Thirty-five LA thrombi were identified at surgery in 27 patients. Compared with the intraoperative findings, per-patient sensitivity, specificity, positive and negative predictive values of two-phase CT were 100 %, 85 %, 69 % and 100 %, and those by using TEE were 93 %, 95 %, 86 % and 97 % in detecting LAA thrombus. After adopting the cut-off value of 0.5 for the LAA/AAL HU ratio, the specificity and positive predictive value of two-phase CT were increased to 96 % and 90 %, respectively. |
2 |
| 32. Korhonen M, Muuronen A, Arponen O, et al. Left atrial appendage morphology in patients with suspected cardiogenic stroke without known atrial fibrillation. PLoS ONE. 10(3):e0118822, 2015. |
Observational-Dx |
40 patients (stroke group), 40 healthy patients (control group) |
To assess whether certain LAA morphologies detected in cardiac computed tomography (cCT) are associated with acute ischemic stroke of cryptogenicor suspected cardiogenic etiology other than known AF. |
A subgroup of 40 patients was compared to an age- and gendermatched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years). LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, Cauli-Flower) modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%), ChickenWing (23.4%, 37.5%, 10.0%), WindSock (47.7%, 35.0%, 67.5%), and CauliFlower (19.8%, 22.5%, 2.5%). The distribution of morphology types differed significantly (P<0.001) between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001) in the matched stroke subgroup (55%) than the control group (6%). LAA volumes were significantly larger (P<0.001) in both stroke study groups compared to controls patients. |
2 |
| 33. Hozawa M, Morino Y, Matsumoto Y, et al. 3D-computed tomography to compare the dimensions of the left atrial appendage in patients with normal sinus rhythm and those with paroxysmal atrial fibrillation. Heart Vessels. 33(7):777-785, 2018 Jul. |
Observational-Dx |
30 PAF patients; 30 NSR patients |
To investigate differences in LAA structures in patients with PAF and those with normal sinus rhythms (NSR) using 3D-computed tomography (3D-CT), which allows us to visualize complicated LAA structures at high spatial resolution. |
After reconstruction of 3D LAA images, anatomical parameters of the LAA were measured and compared according to three proposed definitions of the LAA orifice plane determined by the following anatomical landmarks: DEF#1, center of warfarin ridge and centerline of proximal left circumflex artery; DEF#2, slope of warfarin ridge and mitral valve annulus; DEF#3, observers' discretion by progressive rotation using the observers' best estimate without the use of landmarks. The LAA volumes of the PAF groups were significantly greater than the NSR group according to all 3 definitions (DEF#1: 1.43 times, DEF#2: 1.44 times, and DEF#3: 1.36 times greater). The LAA orifice area was significantly larger in PAF than in NSR according to DEF#2, but was similar by DEF#1 and DEF#3. Intra-observer and inter-observer variations for any LAA measurements were very low. |
3 |
| 34. Dieker W, Behnes M, Fastner C, et al. Impact of left atrial appendage morphology on thrombus formation after successful left atrial appendage occlusion: Assessment with cardiac-computed-tomography. Sci. rep.. 8(1):1670, 2018 01 26. |
Observational-Dx |
30 patients |
To evaluate for the first time the incidences and degree thrombosis within the LAA 6 months after successful LAACdepending on LAA morphologies as well as the implanted occlusion devices. |
There was no significant difference in the level of thrombosis regarding LAA morphology or the type of chosen occlusion device. The rates of complete LAA thrombosis was 40% in broccoli type, 33% in windsock and 15% in chicken wing type. Independently of LAA type, 13% had none and 60% incomplete thrombosis. The ratio of density (LA/LAA) was 0.14 in patients with complete thrombosis and 0.67 in those with none or incomplete thrombosis. |
2 |
| 35. Bittencourt MS, Achenbach S, Marwan M, et al. Left ventricular thrombus attenuation characterization in cardiac computed tomography angiography. J Cardiovasc Comput Tomogr 2012;6:121-6. |
Observational-Dx |
31 patients |
To identify typical thrombi attenuation of left ventricular thrombi with the use of CT measurement. |
Mean (±SD) CT attenuation of all left ventricular thrombi in 31 patients was 43.2 ± 15.3 HU (range, 25-80 HU). Mean CT densities of septal and lateral myocardial wall were 102.9 ± 23.1 HU (range, 63-155 HU) and 99.3 ± 28.7 HU (range, 72-191 HU), respectively, and were thus significantly higher than the CT attenuation of thrombi (P < 0.001). A threshold of 65 HU yielded a sensitivity, specificity, and positive and negative predictive values of 94%, 97%, 94%, and 97%, respectively, to differentiate thrombus from the myocardial wall. The mean ratio between CT attenuation of thrombus and CT attenuation within the ascending aorta was 0.11 ± 0.05 (range, 0.04-0.23), which was significantly lower compared with the mean ratio between CT attenuation of the myocardial wall and the CT attenuation within the ascending aorta. |
4 |
| 36. Kim IC, Chang S, Hong GR, et al. Comparison of Cardiac Computed Tomography With Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients With Infective Endocarditis in the Era of 3-Dimensional Images. Circ Cardiovasc Imaging. 11(3):e006986, 2018 03. |
Observational-Dx |
75 patients (53 males, 22 females) |
To compare the diagnostic performance of computed tomography (CT) and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE). |
The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (=10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess. |
2 |
| 37. Erba PA, Pizzi MN, Roque A, et al. Multimodality Imaging in Infective Endocarditis: An Imaging Team Within the Endocarditis Team. Circulation 2019;140:1753-65. |
Review/Other-Dx |
N/A |
To summarize the current knowledge of the multimodality imaging (MMI) approach in infective endocarditis (IE) with the intent of providing evidence-based recommendations for each imaging technique and practical algorithms for the integrated use of MMI in different IE clinical scenarios. |
No results stated in the abstract. |
4 |
| 38. Feuchtner GM, Stolzmann P, Dichtl W, et al. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 2009;53(5):436-444. |
Observational-Dx |
37 consecutive patients |
To determine the value of multislice CT for the assessment of valvular abnormalities compared with TEE and intraoperative findings in patients with infective endocarditis. |
CT had sensitivity 97%, specificity 88%, PPV 97%, and NPV 88% on a per-patient basis (n = 37; excellent intermodality agreement kappa = 0.84). CT correctly identified 26/27 (96%) patients with valvular vegetations and 9/9 (100%) patients with abscesses/pseudoaneurysms compared with the intraoperative specimen. On a per-valve-based analysis, diagnostic accuracy for the detection of vegetations and abscesses/pseudoaneurysms compared with surgery was: sensitivity 96%, specificity 97%, PPV 96%, NPV 97%, and sensitivity 100%, specificity 100%, PPV 100%, NPV 100%, respectively. Multislice CT shows good results in detecting valvular abnormalities in infective endocarditis and could be applied in preoperative planning and exclusion of coronary artery disease before surgery. |
2 |
| 39. Araoz PA, Mulvagh SL, Tazelaar HD, Julsrud PR, Breen JF. CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation. Radiographics 2000;20:1303-19. |
Review/Other-Dx |
20 patients |
To present selected images from these examinations, along with correlative echocardiographic images, and review the literature for each tumor type. |
No results available. |
4 |
| 40. Kassop D, Donovan MS, Cheezum MK, et al. Cardiac Masses on Cardiac CT: A Review. Curr Cardiovasc Imaging Rep 2014;7:9281. |
Review/Other-Dx |
N/A |
To define the characteristic imaging features of commonly encountered and selected cardiac masses and define the role of cardiac CT among noninvasive imaging options. |
No results avaialble. |
4 |
| 41. Mesurolle B, Qanadli SD, Merad M, El Hajjam M, Mignon F, Lacombe P. Dual-slice helical CT of the thoracic aorta. J Comput Assist Tomogr. 24(4):548-56, 2000 Jul-Aug. |
Review/Other-Dx |
n/a |
To describe the potential of helical CT using dual-slice technology to evaluate thoracic aortic diseases such dissection, aneurysm, trauma, infection, inflammation, thromboembolic disease, and postoperative complications. |
No results available. |
4 |
| 42. Ryoo S, Chung JW, Lee MJ, et al. An Approach to Working Up Cases of Embolic Stroke of Undetermined Source. Journal of the American Heart Association. 5(3):e002975, 2016 Mar 22. |
Observational-Dx |
321 patients with acute infarcts from cryptogenic embolism |
To investigate the clinical and radiological characteristics of these 3 common causes of cryptogenic embolism to develop models for decision making in etiologic workups. |
Patients were divided into 3 groups-aortic arch atheroma (n=40), patent foramen ovale (n=153), and paroxysmal atrial fibrillation (n=128)-based on extensive cardiologic workups. We used a multinomial logistic regression analysis to detect the clinical and diffusion-weighted imaging factors associated with the probability of aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. Clinical and radiological features differed among the groups. The patent foramen ovale group had a healthy vascular risk factor profile and showed posterior circulation involvement compared with other groups (P<0.01). In contrast, paroxysmal atrial fibrillation-related strokes had higher initial National Institutes of Health Stroke Scale (NIHSS) scores and larger lesions than the other groups (P<0.001). The aortic arch atheroma group had clinical features similar to those of the paroxysmal atrial fibrillation group but showed small lesions scattered in multiple vascular territories (P<0.001). Multivariate regression analysis revealed that age, initial NIHSS score, lesion size (=20 mm), multiple (=3) lesions, and involvement of posterior circulation or multiple vascular territories differentiated the 3 groups (pseudo, R(2)=0.656). The prediction ability of this model was validated in the external validation cohort (n=117, area under the curve 0.78). |
3 |
| 43. Krishnam MS, Tomasian A, Malik S, Desphande V, Laub G, Ruehm SG. Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases. Eur Radiol. 20(6):1311-20, 2010 Jun. |
Observational-Dx |
50 patients |
To determine the image quality and diagnostic accuracy of 3-D unenhanced SSFP MRA for the evaluation of thoracic aortic diseases. |
Abnormal aortic findings, including aneurysm (n = 47), coarctation (n = 14), dissection (n = 12), aortic graft (n = 6), IMH (n = 11), mural thrombus in the aortic arch (n = 1), and penetrating aortic ulcer (n = 9), were confidently detected on both datasets. Sensitivity, specificity, and diagnostic accuracy of SSFP MRA for the detection of aortic disease were 100% with contrast enhanced-MRA serving as a reference standard. Image quality of the aortic root was significantly higher on SSFP MRA (P<0.001) with no significant difference for other aortic segments (P>0.05). Signal-to-noise ratio and contrast-to-noise ratio values were higher for all segments on SSFP MRA (P<0.01). |
3 |
| 44. Gebker R, Gomaa O, Schnackenburg B, Rebakowski J, Fleck E, Nagel E. Comparison of different MRI techniques for the assessment of thoracic aortic pathology: 3D contrast enhanced MR angiography, turbo spin echo and balanced steady state free precession. Int J Cardiovasc Imaging. 23(6):747-56, 2007 Dec. |
Observational-Dx |
100 patients with suspected or known thoracic aortic diseases |
To compare two non-contrast 2D techniques with the current contrast-enhanced MRI standard 3D technique for the routine assessment of thoracic aortic pathologies. |
Compared to CE-MRA, balanced SSFP and TSE allowed for the detection of a significantly higher number of relevant pathologies (thickened aortic wall and signs of emergency) in less time. No significant differences were found among the sequences for the identification of aneurysms, dissection membranes and thrombi. No single technique was able to address all clinically relevant issues. TSE was associated with a better image quality compared to balanced SSFP, which however did not translate into a significantly improved diagnostic accuracy. |
2 |
| 45. Chen J, Zhang H, Zhu D, Wang Y, Byanju S, Liao M. Cardiac MRI for detecting left atrial/left atrial appendage thrombus in patients with atrial fibrillation : Meta-analysis and systematic review. Herz. 44(5):390-397, 2019 Aug. |
Meta-analysis |
7 articles (582 patients) |
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. |
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. |
Good |
| 46. Srichai MB, Junor C, Rodriguez LL, et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 2006;152:75-84. |
Observational-Dx |
61 patients with ischemic heart disease |
To evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging (MRI) with transthoracic (TTE) and transesophageal echocardiography (TEE) for the diagnosis of LV thrombi. |
Left ventricular thrombus was present in 106 (29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events (6.1% vs 0.8%, P < .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity (88% +/- 9% and 99% +/- 2%, respectively) compared with TTE (23% +/- 12% and 96% +/- 3.6%, respectively) and TEE (40% +/- 14% and 96% +/- 3.6%, respectively) for thrombus detection. |
3 |
| 47. Rustemli A, Bhatti TK, Wolff SD. Evaluating cardiac sources of embolic stroke with MRI. Echocardiography 2007;24:301-8; discussion 08. |
Review/Other-Dx |
N/A |
To focus on the advantages and limitations of echocardiography and cardiac magnetic resonance (CMR) imaging in diagnosing patients suspected of having an embolic stroke and the role these modalities play in clinical practice today. |
No results available. |
4 |
| 48. Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. [Review]. Radiology. 268(1):26-43, 2013 Jul. |
Review/Other-Dx |
N/A |
To provide an overview of cardiac masses and reviews the optimal MR imaging techniques for their assessment. |
No results available. |
4 |
| 49. Weinsaft JW, Kim J, Medicherla CB, et al. Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR. JACC Cardiovasc Imaging. 9(5):505-15, 2016 05. |
Experimental-Dx |
201 patients |
To determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancement (DE) cardiac magnetic resonance (CMR). |
A total of 201 patients were studied; 8% had thrombus according to DE-CMR. All thrombi were apically located; 94% of thrombi occurred in the context of a left anterior descending (LAD) infarct-related artery. Although patients with thrombus had more prolonged chest pain and larger MI (p = 0.01), only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus was associated with stepwise increments in basal ? apical contractile dysfunction on echo and quantitative cine-CMR; the echo-measured apical wall motion score was higher among patients with thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection fraction and peak ejection rates (both p < 0.005). Thrombus-associated decrements in apical contractile dysfunction were significant even among patients with LAD infarction (p < 0.05). The echo-based apical wall motion score improved overall performance (area under the curve 0.89 ± 0.44) for thrombus compared with ejection fraction (area under the curve 0.80 ± 0.61; p = 0.01). Apical wall motion partitions would have enabled all patients with LV thrombus to be appropriately referred for DE-CMR testing (100% sensitivity and negative predictive value), while avoiding further testing in more than one-half (56% to 63%) of patients. |
1 |
| 50. He YQ, Liu L, Zhang MC, Zeng H, Yang P. Dual-Energy Computed Tomography-Enabled Material Separation in Diagnosing Left Atrial Appendage Thrombus. Tex Heart Inst J. 46(2):107-114, 2019 Apr. |
Observational-Dx |
24 patients (12 with and 12 without left atrial appendage thrombi) |
To explore the applicability and potential clinical use of cardiac spectral CT imaging to differentiate LAA thrombi from LAA pectinate muscles. |
On the 70-keV monochromatic and iodine-specific images, the left atrial appendage pectinate muscles and thrombi appeared as areas of hypodense attenuation. On the blood-specific images, similar areas of high attenuation were observed in the thrombi and cavities, whereas lower attenuation was noticed in the pectinate muscles. The quantitative iodine and blood densities in the pectinate muscles were lower than those in the cavities (P <0.001). The iodine densities in the thrombi were lower than those in the cavities (P <0.001); however, blood densities did not differ significantly between the thrombi and cavities (P=0.192). Compared with the pectinate muscles, the thrombi showed lower blood-density differences (P=0.003) and higher iodine-density differences (P=0.006) in relation to the cavities. |
3 |
| 51. Kumar V, Nanda NC. Is it time to move on from two-dimensional transesophageal to three-dimensional transthoracic echocardiography for assessment of left atrial appendage? Review of existing literature. [Review]. Echocardiography. 29(1):112-6, 2012. |
Review/Other-Dx |
N/A |
To review the existing literature comparing the relative advantages and disadvantages of 3D TTE versus 2D TEE and found that in patients with good acoustic windows 3D TTE had similar efficacy for detecting LAA thrombus. |
No results available. |
4 |
| 52. Nakanishi K, Homma S. Role of echocardiography in patients with stroke. [Review]. J Cardiol. 68(2):91-9, 2016 08. |
Review/Other-Dx |
N/A |
To review potential cardiac sources of stroke and discusses the role of echocardiography in clinical practice. |
No results available. |
4 |
| 53. de Bruijn SF, Agema WR, Lammers GJ, et al. Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke 2006;37:2531-4. |
Observational-Dx |
231 patients with TIA or stroke |
To identify a potential cardiac source of embolism in patients compared with a TIA or stroke without a definite cause after the standardized work-up, and without clear indication or contraindication for anticoagulation. |
A potential cardiac source of embolism was detected in 55% (127/ 231) of the patients by echocardiography, in 39% (90/231) only identified on TEE. Major risk factors, with an absolute indication for oral anticoagulation, were detected in 20% (46/231) of the patients, in 16% (38/231) of all patients identified on TEE only. A thrombus in the left atrial appendage was the most common major risk factor (38 patients, 16%). The presence of major risk factors was independent of age (chi2=1.48; P=0.224). The difference in proportions of cardiac sources detected in favor of TEE was highly significant in both patients < or = 45 years of age (10/39, P=0.002) and in those > 45 years of age (80/192; P<0.004). |
3 |
| 54. Pearson AC, Labovitz AJ, Tatineni S, Gomez CR. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol 1991;17:66-72. |
Observational-Dx |
79 patients with unexplained stroke or transient ischemic attack |
To evaluate the utility of trans-esophageal echocardiography in patients presenting with unexplained stroke and compare the diagnostic yield of transesophageal and transthoracic echocardiography in this group of patients. |
Transesophageal echocardiography identified a potential cardiac source of embolism in 57% of the overall study group compared with only 15% by transthoracic echocardiography (p less than 0.0005). Compared with transthoracic echocardiography, transesophageal echocardiography more frequently identified atrial septal aneurysm associated with a patent foramen ovale (9 versus 1 of 79 patients, p less than 0.005), left atrial thrombus or tumor (6 versus 0 of 79 patients, p less than 0.05) and left atrial spontaneous contrast (13 versus 0 of 79 patients, p less than 0.0005). All cases of left atrial thrombus or spontaneous contrast were identified in patients with clinically identified cardiac disease. In the 38 patients with no cardiac disease, transesophageal echocardiography identified isolated atrial septal aneurysm and atrial septal aneurysm with a patent foramen ovale more frequently than transthoracic echocardiography (8 versus 2 of 38 patients, p less than 0.05). The two techniques had a similar rate of identifying apical thrombus and mitral valve prolapse. Overall, transesophageal echocardiography identified abnormalities in 39% of patients with no cardiac disease versus 19% for transthoracic echocardiography (p less than 0.005). |
1 |
| 55. Ginsburg M, Obara P, Lambert DL, et al. ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia. J Am Coll Radiol 2018;15:S332-S40. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging of mesenteric ischemia. |
No results stated in abstract. |
4 |
| 56. Labruto F, Blomqvist L, Swedenborg J. Imaging the intraluminal thrombus of abdominal aortic aneurysms: techniques, findings, and clinical implications. [Review]. J Vasc Interv Radiol. 22(8):1069-75; quiz 1075, 2011 Aug. |
Review/Other-Dx |
N/A |
To describe the techniques, findings, clinical implications, advantages, and disadvantages of imaging the ILT by ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging. |
No results stated in abstract. |
4 |
| 57. Litmanovich D, Bankier AA, Cantin L, Raptopoulos V, Boiselle PM. CT and MRI in diseases of the aorta. AJR Am J Roentgenol 2009;193:928-40. |
Review/Other-Tx |
N/A |
To review the role of CT and MRI in the diagnosis, follow-up, and surgical planning of aortic aneurysms and acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer. Also provide a systematic approach to the definition, causes, natural history, and imaging principles of these diseases. |
No results stated in the abstract. |
4 |
| 58. Nguyen VL, Leiner T, Hellenthal FA, et al. Abdominal aortic aneurysms with high thrombus signal intensity on magnetic resonance imaging are associated with high growth rate. Eur J Vasc Endovasc Surg. 48(6):676-84, 2014 Dec. |
Observational-Dx |
35 Patients |
To investigate whether AAAs with high thrombus signal intensity (SI) at T1-weighted (T1w) magnetic resonance imaging (MRI) exhibit a faster aneurysm growth rate. |
A total of 35 patients (m/f: 26/9; age 72 7 years; AAA maximal diameter 4.9 0.5 cm) were included. Mean aneurysm growth rate for patients in group A (n ¼ 11, 1.87 cm2/0.5 year) was two-fold higher than group B (n ¼ 17, 0.78 cm2/0.5 year, p ¼ .005) and eight-fold higher than group C (n ¼ 7, 0.23 cm2/0.5 years, p ¼ .004) at 6 months’ follow-up. At 12 months’ follow-up, the mean aneurysm growth rate remained significantly higher in group A (n ¼ 7, 3.03 cm2/year) than groups B (n ¼ 10, 1.63 cm2/year, p ¼ .03) and C (n ¼ 7, 0.73 cm2/year, p ¼ .004). The reproducibility for thrombus SI measurements was found to be high with a coefficient of variation of 6.2%. Aneurysm maximal cross-sectional area at baseline was not significantly different for the three groups. |
2 |
| 59. Expert Panel on Vascular Imaging:, Weiss CR, Azene EM, et al. ACR Appropriateness Criteria R Sudden Onset of Cold, Painful Leg. [Review]. J. Am. Coll. Radiol.. 14(5S):S307-S313, 2017 May. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for sudden onset of cold, painful leg. |
No results stated in abstract |
4 |
| 60. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
