Not applicable, Ischaemia / Infarction, Acute, Computer Applications-Detection, diagnosis, MR, CT-Angiography, Emergency, Cardiac, Arteries / Aorta
S. M. Yoo; Bundang/KR
Elevated cardiac troponin in serum is a sensitive and specific marker for the presence of myocardial injury. However, underlying etiology of myocardial injury still remains unclear with elevated troponin alone. Identification of underlying etiology in troponin positive patients with acute chest pain is paramount of importance as various entities with heterogenous prognosis result in this condition. In clinical practice, positive troponin patients accompanied by chest pain or ECG changes are often investigated with coronary angiography as a standard downstream test. As a problem-solving tool, Cardiac MR is often performed in patients with troponin positive with non-obstructive coronary artery (TPNOCA) on coronary angiography. This is a classic pathway to evaluate patients with acute chest pain and elevated cardiac troponin in serum. However, cardiac CT is increasingly being used in patients with acute chest pain and mild or borderline cardiac troponin increase. Moreover, even if initial cardiac troponin was normal at the time when cardiac CT was ordered, second-set cardiac troponin level may be increased, leading to cardiac CT as an initial imaging tool for TPNOCA. In this context, cardiac CT can be a first-line imaging tool to identify and triage TPNOCA. Thus, radiologists should be familiar with cardiac CT findings of various conditions resulting in TPNOCA. This review will discuss basic concepts of TPNOCA and provide typical CT findings of TPNOCA.