Learning objectives
To illustrate how the Triple-Rule-Out (TRO) CT protocol, associated with the evaluation of Late Iodine Enhancement (LIE) and the quantification of Extracellular Volume Fraction (ECV), can improve the diagnostic rate in patients with acute chest pain and troponin elevation.
Background
The Triple-Rule-Out CT protocol is extremely useful for assessing the presence of Pulmonary Embolism (PE), Coronary Artery Disease (CAD), or Acute Aortic Syndromes [1][2]. A recent algorithm has been proposed for analyzing the myocardium with the study of LIE and ECV in addition to the vascular structures[3].
Findings and procedure details
In patients with acute chest pain, the TRO protocol can confirm or rule out pathologies such as CAD, PE, or AAS simultaneously in one examination [1] [2]. However, chest pain with a troponin increase can be caused by non-coronary factors that should be identified to improve patient management [4]. Recently, some studies have shown that a cardiac CT scan may identify other myocardial pathologies such as myocarditis, Takotsubo cardiomyopathy, or Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) in the absence of CAD, PE, or AAS...
Conclusion
The simultaneous evaluation of TRO, LIE, and ECV by CT improve the diagnostic, therapeutic, and prognostic performances in a patient with chest pain to low to intermediate risk[3].
Personal information and conflict of interest
D. Sferratore:
Nothing to disclose
P. Marra:
Nothing to disclose
G. Muscogiuri:
Nothing to disclose
J. Usai:
Nothing to disclose
E. Faietti:
Nothing to disclose
P. A. Bonaffini:
Nothing to disclose
S. Sironi:
Nothing to disclose
References
[1] Wnorowski, Amelia M., and Ethan J. Halpern. "Diagnostic yield of triple-rule-out CT in an emergency setting." American Journal of Roentgenology 207.2 (2016): 295-301.
[2] Burris, Alfred C., et al. "Triple rule out versus coronary CT angiography in patients with acute chest pain: results from the ACIC consortium." JACC: Cardiovascular Imaging 8.7 (2015): 817-825.
[3] Palmisano, Anna, et al. "Myocardial late contrast enhancement CT in troponinpositive acute chest pain syndrome." Radiology 302.3 (2022): 545-553.
[4] M. D. A. L. M. e. a. Rengo, "Impact of...