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Chest pain CT in the emergency department: Watch out for the myocardium


Higashigaito, Kai; Hinzpeter, Ricarda; Baumueller, Stephan; Benz, David; Manka, Robert; Keller, Dagmar I; Alkadhi, Hatem; Morsbach, Fabian (2018). Chest pain CT in the emergency department: Watch out for the myocardium. European Journal of Radiology Open, 5:202-208.

Abstract

Rationale and Objectives To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CT, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CT, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results HM was identified in 27/300 patients (9%): 12/179 in chest-pain CT (7%) and 15/121 in chest-pain CT (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients' history. Chest-pain CT identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI. Conclusion HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CT when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.

Abstract

Rationale and Objectives To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CT, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CT, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results HM was identified in 27/300 patients (9%): 12/179 in chest-pain CT (7%) and 15/121 in chest-pain CT (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients' history. Chest-pain CT identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI. Conclusion HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CT when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2018
Deposited On:07 Dec 2018 11:31
Last Modified:17 Sep 2019 19:45
Publisher:Elsevier
ISSN:2352-0477
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.ejro.2018.10.001
PubMed ID:30456219

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