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Acute coronary syndrome: evaluation of detection capability using non-electrocardiogram-gated parenchymal phase CT imaging

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Abstract

Purpose

To evaluate the capability to detect acute coronary syndrome (ACS) by using non-electrocardiogram-gated parenchymal phase CT imaging.

Materials and methods

Of 962 consecutive patients who underwent emergent coronary angiography for suspected ACS, 32 with ACS who underwent CT ≤24 h before angiography and 15 without ACS who underwent CT ≤24 h before or after angiography were included. Parenchymal phase was acquired at 100-s scan delay. The presence of a myocardial perfusion defect (MPD) on the left ventricle (a decrease of >20 HU) and its capability to detect ACS were evaluated. Results were compared with laboratory findings.

Results

MPD was detected in 29 of 32 ACSs. The sensitivity, specificity, and positive and negative predictive values were 91 % (29/32), 93 % (14/15), 97 % (29/30), and 82 % (14/17), respectively. The sensitivities of ST- and non-ST-elevation ACSs were 89 % (16/18) and 93 % (13/14), respectively, without significant difference (P > 0.99). Of the CT-detectable ACS, non-ST-elevation on the electrocardiogram and a normal creatine kinase-myocardial band were observed in 41 % (12/29) and 24 % (7/29), respectively.

Conclusion

ACS is highly detectable even using conventional parenchymal phase CT imaging. Therefore, even when CT is non-gating, radiologists should carefully evaluate the heart to avoid overlooking ACS.

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Abbreviations

ACS:

Acute coronary syndrome

AMI:

Acute myocardial infarction

CAG:

Coronary angiography

CK-MB:

Creatine kinase-myocardial band

ECG:

Electrocardiogram

H-FABP:

Heart-type fatty acid-binding protein

HU:

Hounsfield units

MPD:

Myocardial perfusion defect

NSTEMI:

Non-ST-elevation myocardial infarction

STEMI:

ST-elevation myocardial infarction

UA:

Unstable angina

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Acknowledgments

The authors would like to thank Takeshi Numasawa from the Department of Medical Radiologic Technology, Niigata City General Hospital, for correcting the patient data.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuou-ku, Niigata, Japan

    Motohiko Yamazaki, Takeshi Higuchi, Toshikazu Shimokoshi & Takao Kiguchi

  2. Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuou-ku, Niigata, Japan

    Yosuke Horii, Norihiko Yoshimura & Hidefumi Aoyama

Authors
  1. Motohiko Yamazaki
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  2. Takeshi Higuchi
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  3. Toshikazu Shimokoshi
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Correspondence to Motohiko Yamazaki.

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Conflicts of interest

Hidefumi Aoyama has a consulting role with Brainlab, AG, outside the submitted work.

The other authors declare that they have no conflict of interest.

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Yamazaki, M., Higuchi, T., Shimokoshi, T. et al. Acute coronary syndrome: evaluation of detection capability using non-electrocardiogram-gated parenchymal phase CT imaging. Jpn J Radiol 34, 331–338 (2016). https://doi.org/10.1007/s11604-016-0527-5

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  • DOI: https://doi.org/10.1007/s11604-016-0527-5

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