Purpose
To estimate the prevalence and diagnostic value of myocardial hypoenhancement by multidetector spiral computed tomography (MDCT) in patients with acute coronary syndrome with non-ST segment elevation (NSTE-ACS) and compare with regional wall motion (RWM) abnormalities by echocardiography (ECHO).
Methods and Materials
43 patients with NSTE-ACS and without previous myocardial infarction were enrolled in study.
MDCT was performed using 64-slice CT scanner (Aquilion,
Toshiba,
Japan; gantry rotation time 400 ms; 64 x 0.5 mm detector collimation,
retrospective ECG gating) before invasive coronarography and echocardiography.
We determined the depth and location of myocardial hypoenhencement,
comparing it with RWM abnormalities by ECHO.
The areas of myocardial hypoenhancement were classified into transmural (more than 50% of left ventricular myocardial thickness involved) and subendocardial (less than 50%).
MDCT was also used...
Results
We studied 21 patients with non-ST segment elevation myocardial infarction (group 1) and 22 patients with unstable angina (group 2).
The sensitivity,
specifity,
negative and positive predictive values of the myocardial hypoenhencement by MDCT,
regional wall motion (RWM) abnormalities by echocardiography (ECHO) and occlusion of symptom-related artery (SRA) by MDCT in the diagnosis of myocardial infarction are shown in the table 1.
Localization of RWM abnormalities by ECHO in all cases coincided with area of myocardial hypoenhancement by MDCT.
Conclusion
Myocardial hypoenhencement detected by MDCT showed higher sensitivity in diagnosis of myocardial infarction compared with regional wall motion abnormalities detected by echocardiography.
Absence of symptom-related artery occlusion by MDCT had the greatest specificity and negative predictive value in exclusion of myocardial infarction.
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