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摘要
Objectives-We investigated whether transesophageal echocardiography (TEE) assisted with a computer-aided diagnostic (CAD) algorithm was superior to TEE in diagnosing left atrial (LA)/left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) in a single prospective study. Methods-Transesophageal echocardiography was performed in patients with AF, and images were reconstructed. Gray level co-occurrence matrix-based features were calculated and then classified using an artificial neural network The original data and processed images by the CAD system were studied by 5 radiologists independently in a blind manner. The diagnostic performance of each radiologist was evaluated. Results-One hundred thirty patients with AF were investigated. Thirty-one patients (23.9%) had a diagnosis of LA/LAA thrombi. The mean sensitivity +/- SD of TEE for LA/LAA thrombi was 0.933 +/- 0.027, which was noticeably improved by CAD (0.955 +/- 0.021; P < .05). The specificity of TEE was 0.811 +/- 0.055, which was markedly lower than that by TEE plus CAD (0.970 +/- 0.009; P < .05). The positive predictive value of TEE was low (0.613 +/- 0.073) compared to that of TEE plus CAD (0.908 +/- 0.027; P < .001), whereas the negative predictive values were comparable for TEE, CAD, and TEE plus CAD. Diagnosis of an LA/LAA thrombus by TEE plus CAD had a higher accuracy rate (0.966 +/- 0.011) than that by TEE (0.840 +/- 0.047; P < .01). The mean area under the receiver operating characteristic curve (A(z)) for TEE was 0.834 +/- 0.009 (95% confidence interval [CI], 0.815-0.852), which was markedly lower than the A(z) for TEE plus CAD (0.932 +/- 0.005; 95% CI, 0.921-0.943). The use of CAD significantly improved the A(z) values for all 5 radiologists (P < .001). Conclusions-The CAD algorithm significantly improves the diagnostic accuracy of TEE for LA/LAA thrombi in patients with AF.
