Sensitivity and specificity were 23% and 96%, respectively, for the detection of left ventricular thrombus compared to findings at surgery or pathology [46]. In the detection of left ventricle thrombus, contrast-enhanced TTE had a 64% sensitivity and a 99% specificity compared to a delayed enhancement cardiac MR standard [49]. TTE can also be applied for the diagnosis of valvular disease and cardiac neoplasms. There is no evidence to support the use of TTE in the evaluation of aortic thrombus. Variant 4: Known multiorgan system arterial occlusions. Suspected embolic etiology. Next imaging study to determine source. The variant assumes that multiorgan arterial occlusions have already been established. Typically, these diagnoses are made by CTA, arteriography, or MRA, although the clinical examination or another imaging study could also be used. CT Heart Function and Morphology With IV Contrast The primary role of cardiac CT in the initial evaluation of multiorgan system arterial embolic occlusion is in the workup of cardiac thrombus as a source. Multiple studies have established high rates of atrial thrombus detection by cardiac CT compared to TEE [18-27]. Meta-analyses have found sensitivities of 96% to 99% and specificities of 92% to 94% for detection of left atrial or left atrial appendage thrombus with cardiac CT compared to a TEE reference standard [28-30]. When compared with intraoperative findings, cardiac CT was 100% sensitive and 85% specific for finding left atrial thrombus [31]. Complex left atrial appendage morphologies, which predispose to thrombus formation, can also be characterized by cardiac CT [32-34]. Additionally, cardiac CT can differentiate left ventricular thrombus from the myocardial wall, with 1 study demonstrating a sensitivity, specificity, and 10 Workup of Noncerebral Systemic Arterial Embolic Source positive and negative predictive values of 94%, 97%, 94%, and 97%, respectively [35].
Workup of Noncerebral Systemic Arterial Embolic Source. Sensitivity and specificity were 23% and 96%, respectively, for the detection of left ventricular thrombus compared to findings at surgery or pathology [46]. In the detection of left ventricle thrombus, contrast-enhanced TTE had a 64% sensitivity and a 99% specificity compared to a delayed enhancement cardiac MR standard [49]. TTE can also be applied for the diagnosis of valvular disease and cardiac neoplasms. There is no evidence to support the use of TTE in the evaluation of aortic thrombus. Variant 4: Known multiorgan system arterial occlusions. Suspected embolic etiology. Next imaging study to determine source. The variant assumes that multiorgan arterial occlusions have already been established. Typically, these diagnoses are made by CTA, arteriography, or MRA, although the clinical examination or another imaging study could also be used. CT Heart Function and Morphology With IV Contrast The primary role of cardiac CT in the initial evaluation of multiorgan system arterial embolic occlusion is in the workup of cardiac thrombus as a source. Multiple studies have established high rates of atrial thrombus detection by cardiac CT compared to TEE [18-27]. Meta-analyses have found sensitivities of 96% to 99% and specificities of 92% to 94% for detection of left atrial or left atrial appendage thrombus with cardiac CT compared to a TEE reference standard [28-30]. When compared with intraoperative findings, cardiac CT was 100% sensitive and 85% specific for finding left atrial thrombus [31]. Complex left atrial appendage morphologies, which predispose to thrombus formation, can also be characterized by cardiac CT [32-34]. Additionally, cardiac CT can differentiate left ventricular thrombus from the myocardial wall, with 1 study demonstrating a sensitivity, specificity, and 10 Workup of Noncerebral Systemic Arterial Embolic Source positive and negative predictive values of 94%, 97%, 94%, and 97%, respectively [35].