| Japanese |
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| Title | 心プールシンチグラフィによる左房内血栓の診断 |
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| Subtitle | 原著 |
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| Authors | 植原敏勇*, 西村恒彦*, 林田孝平*, 高宮誠*, 小塚隆弘*,** |
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| Organization | *国立循環器病センター放射線診療部, **現;大阪大学医学部放射線科 |
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| Journal | 核医学 |
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| Volume | 25 |
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| Number | 6 |
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| Page | 513-523 |
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| Year/Month | 1988/6 |
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| Article | 原著 |
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| Publisher | 日本核医学会 |
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| Abstract | 「要旨」 僧帽弁疾患に合併する左房内血栓の診断は, 患者の治療方針・手術適応の決定の上で重要である. この左房内血栓の好発部位は左心耳であるため, 心エコー図では診断が困難な場合がある. 一方, 99mTC赤血球標識心プールシンチグラフィにて僧帽弁疾患の左心耳が鮮明に描出されることが多いが, 左心耳に血栓が形成されると左心耳は光子欠損像として表現される. そこで手術時に左房内血栓の有無が確認された僧帽弁疾患60例において, 術前の心プールシンチグラフィによる左心耳の描出の有無から左房内血栓の存在診断を検討した. この結果, ファーストパスおよび平衡相における左房内血栓検出のSensitivityはそれぞれ83%と67%, Specificityは79%と54%, Accuracyは80%と57%であり, 前者の左房内血栓検出精度は特に良好であった. ただし, ファーストパスによる2例のfalse negativeは左心耳以外の左房内血栓症例であり, 左心耳内に限った本法の血栓検出精度はSensitivity 100%, Specificity 80%, Accuracy 83%と良好であった. 左心耳が小さい場合に血栓との鑑別が困難でfalse positiveの原因となった. しかし, negative predictive valueが高く, 左心耳が明瞭に認められれば左心耳に血栓はない確率は高かった. 一方, 平衡相における左房内血栓検出精度はやや劣ったが, 特徴的な左心耳像が描出されることもあり, 補助診断として有用と考えられた. |
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| Practice | 臨床医学：一般 |
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| Keywords | Left atrial thrombus, Left atrial appendage, Radionuclide angiography, Echocardiography, Coronary arteriography |
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| English |
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| Title | Diagnosis of Left Atrial Thrombus by Technetium-99m Radionuclide Angiography |
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| Subtitle | Original Articles |
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| Authors | Toshiisa UEHARA, Tsunehiko NlSHIMURA, Kohei HAYASHIDA, Makoto TAKAMIYA, Takahiro KOZUKA |
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| Authors(kana) | |
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| Organization | Department of Radiology, Cardiovascular Center |
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| Journal | The Japanese Journal of nuclear medicine |
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| Volume | 25 |
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| Number | 6 |
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| Page | 513-523 |
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| Year/Month | 1988/6 |
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| Article | Original article |
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| Publisher | THE JAPANESE SOCIETY OF NUCLEAR MEDICINE |
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| Abstract | [Summary] Detection of left atrial (LA) thrombus in the mitral valve disease is important in the decision of treatment course or indication for operation, The LA thrombus usually locates in the LA appendage. On the other hand, technetium-99m radionuclide angiography labeled by red blood cell (RNA) often shows LA appendage clearly in the mitral valve disease, but when the LA appendage is occupied by LA thrombus, LA appendage will not be demonstrated by RNA. On the basis of this hypothesis, the diagnostic accuracy of RNA to detect LA thrombus by the visualization of LA appendage was evaluated retrospectively in 60 patients of mitral valve disease who had undergone operation and whether the LA thrombus was present or not had been clarified. The sensitivity of first-pass and equilibrium RNA to detect LA thrombus was 83% and 67%, and the specificity 79% and 54%, and the accuracy 80% and 57% respectively. The first-pass RNA showed a good diagnostic accuracy to detect LA thrombus, but there were two cases of false negative those had LA thrombus not located in the LA appendage, and there were 10 cases of false positive those did not have dilated LA appendages. But negative predictive value was so high that the clearly observed LA appendage convinced us of the absence of LA thrombus. The diagnostic accuracy of equilibrium RNA was relatively low but it often demonstrated a characteristic shape of LA appendage, so it seemed useful as an assistant diagnostic method. |
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| Practice | Clinical medicine |
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| Keywords | Left atrial thrombus, Left atrial appendage, Radionuclide angiography, Echocardiography, Coronary arteriography |
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