BACKGROUND: The diagnostic accuracy of multidetector computed tomography(MDCT) in the detection of left atrial / left atrial appendage(LA/LAA) thrombus had been tested in many studies, the results are controversial. AIMS: The aim of the present study was to synthetically evaluate the diagnostic accuracy of MDCT in LA/LAA thrombus. METHODS AND RESULTS: The Pubmed and Embase were searched for published prospective studies which compared CT with transesophageal echocardiogram(TEE) in detecting LA/LAA thrombu prior to march 2014. Descriptive and quantitative information was extracted and MetaDiSc 1.4 was used to perform a meta-analysis. Fifteen prospective clinical controlled trials with 2540 patients fulfilled the inclusion criteria. The pooled sensitivities (SEN):0.957; pooled specificities (SPE): 0.917; pooled positive likelihood ratio (PLR): 22.017; pooled negative likelihood ratio (NLR): 0.060; pooled Diagnostic Odds Ratio (DOR): 437.43; the area under the curve (AUC): 0.9883; Q*-value: 0.9544. However, in the abovementioned indexes, the heterogeneities was statistically significant between studies (p0.05, I250%). In a sub-analysis of studies in which delayed imaging, ECG-gating and heart rate control were performed, not only the diagnostic accuracy but also the heterogeneities were significantly improved(pooled SEN 0.991; pooled SPE 0.989; pooled PLR 60.768; pooled NLR 0.034; pooled DOR 2561.7; AUC 0.9972; Q*-value 0.9806; all the indexes' p-value greater than 0.05 and the I2 were 0%, except the SPE's I2=54.6% ). CONCLUSION: Patients with TEE intolerance or contraindications, MDCT may be an alternative method, especially when the delayed imaging, ECG-gating and heart rate control were performed