Multidetector computed tomography for the detection of left atrial appendage thrombus: a comparative study with transesophageal echocardiography

J Comput Assist Tomogr. Nov-Dec 2007;31(6):905-9. doi: 10.1097/rct.0b013e31803c55e3.


Objective: To determine the diagnostic performance of multidetector computed tomography (MDCT) for the detection of left atrial appendage (LAA) thrombus as compared with transesophageal echocardiography.

Methods: Multidetector computed tomography was evaluated in 43 patients qualitatively for the presence or absence of a filling defect in the LAA and compared with transesophageal echocardiography. Additionally, a ratio of the mean computed tomographic attenuation in the LAA apex to the mean computed tomographic attenuation in the aortic root was used for quantitative evaluation.

Results: A filling defect visualized in the LAA by MDCT corresponded to a sensitivity of 70% (7/10), a specificity of 82% (27/33), and a negative predictive value of 90% (27/30) for detection of LAA thrombus. When using quantitative parameters, MDCT demonstrated a sensitivity of 80% (8/10), a specificity of 73% (24/33), and a negative predictive value of 92% (24/26). Multidetector computed tomography was not able to differentiate LAA thrombus from spontaneous echo contrast by either visual evaluation or by quantitative parameters.

Conclusions: Multidetector computed tomography remains limited for the detection of LAA thrombus. However, a subgroup of patients at very high risk for LAA thrombus may benefit from the high negative predictive value of cardiac MDCT.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aorta / diagnostic imaging
  • Aortography / methods
  • Atrial Appendage / diagnostic imaging*
  • Cohort Studies
  • Contrast Media
  • Echocardiography, Doppler, Pulsed
  • Echocardiography, Transesophageal*
  • Female
  • Heart Diseases / diagnostic imaging*
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Radiographic Image Enhancement / methods
  • Retrospective Studies
  • Sensitivity and Specificity
  • Single-Blind Method
  • Thrombosis / diagnostic imaging*
  • Tomography, X-Ray Computed / methods*
  • Triiodobenzoic Acids


  • Contrast Media
  • Triiodobenzoic Acids
  • iodixanol