STUDY TO KNOW THE ARTERIAL PHASE 128-SLICE MULTIDETECTOR CT ANGIOGRAPHY DIAGNOSTIC ACCURACY FOR DETECTING THROMBUS IN LEFT ATRIAL APPENDAGES IN PATIENTS PREPARED FOR ATRIAL FIBRILLATION ABLATION

Objective: The aim of this study is to determine the Arterial Phase 128-Slice Multidetector CT Angiography diagnostic accuracy for detecting thrombus in Left Atrial Appendage in patients prepared for Atrial Fibrillation Ablation. Place and duration: In the Radiology department of Chaudhry Pervaiz Elahi Institute of Cardiology (CPEIC), Multan in collaboration with Cardiology department for one year duration from October 2017 to October 2018. Methods: The accuracy of MDCT variability in the left atrial thrombus evaluation before AFA and its investigation was done. Before the procedure, 50 MDCT and transesophageal echocardiography examinations were performed. All MDCT images were reviewed by 3 experienced observers to detect the thrombus presence in the left atrial appendage, and transesophageal echocardiograms (TEE) were reviewed by two different readers, which were taken as reference standards. For clinical data; all observers were blinded to and each other. Results: Inter-observer variability was low between the 3 readers of MDCT (P = 0.001, highest kappa statistic, 0.43). Diagnostic accuracy was much different with sensitivities from 100% to 50% and with specificities from 86% to 45%. The ETE reader contract was 97%. Conclusion: MDCT has only a modest diagnostic accuracy and high interobserver variability for detecting left atrial appendage thrombus in subjects done with AFA procedure. The accuracy of MDCT affected by potential factors includes the image quality and the problem in differentiating the clot from the pectinate muscle. It is supposed that MDCT is not the most appropriate procedure for the left atrial thrombus detection by using interpretation standards and existing techniques. Key Words: MDCT, Arterial Phase, diagnostic accuracy, Radiology