Savino G, Herzog C, Costello P, Schoepf U J
Dipartimento di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy.
Radiol Med. 2006 Jun;111(4):481-96. doi: 10.1007/s11547-006-0044-1. Epub 2006 May 29.
The purpose of this study was to evaluate contrast-enhanced electrocardiogram (ECG)-gated 64-slice computed tomography (CT) angiography of the thorax as a triage tool in patients with acute equivocal chest pain.
Technical principles and diagnostic algorithms for using a single ECG-gated 64-slice CT scan for triple rule-out of acute pulmonary embolism, aortic dissection, acute coronary syndromes and other diseases of the chest are introduced. Our experience using this test in 23 patients are reviewed and exemplary cases are illustrated. The total length of hospitalisation and charges for Emergency Department care at the time of discharge were compared with a matched control population that underwent catheter angiography for emergent cardiac workup. Statistical analyses were performed with an independent Student's t test. Mann-Whitney rank sum test was also used on variables that did not have equal variance.
Of the 23 patients, 11 presented without pathological findings, two with extensive pulmonary embolism, two with definite coronary artery disease (CAD) but stenosis <50% and eight with significant CAD (>50% stenosis). Catheter angiography was performed in the latter group, confirming the CT findings in all cases. Nine patients without CT findings were discharged on the same day. In comparison with the control group, length of hospitalisation (p=0.009) and total hospital charges (p<0.001) were significantly reduced.
Our initial experience shows that ECG-gated 64- slice CT angiography of the entire thorax is technically feasible and enables rapid triage of patients to determine underlying cardiac and noncardiac reasons for chest pain. This test may thus help to significantly reduce costs and length of hospitalisation. Prospective studies involving larger groups of patients are required to confirm these findings.
本研究旨在评估胸部对比增强心电图（ECG）门控64层计算机断层扫描（CT）血管造影术作为急性胸痛不明确患者的分诊工具。
介绍了使用单次ECG门控64层CT扫描对急性肺栓塞、主动脉夹层、急性冠状动脉综合征和其他胸部疾病进行三联排除的技术原理和诊断算法。回顾了我们在23例患者中使用该检查的经验，并展示了典型病例。将出院时的住院总时长和急诊科护理费用与接受导管血管造影进行紧急心脏检查的匹配对照组进行比较。采用独立样本t检验进行统计分析。对于方差不相等的变量，还使用了曼-惠特尼秩和检验。
23例患者中，11例无病理发现，2例有广泛肺栓塞，2例有明确冠状动脉疾病（CAD）但狭窄<50%，8例有显著CAD（狭窄>50%）。后一组患者进行了导管血管造影，所有病例均证实了CT检查结果。9例无CT检查异常的患者于同日出院。与对照组相比，住院时长（p = 0.009）和住院总费用（p<0.001）显著降低。
我们的初步经验表明，全胸部ECG门控64层CT血管造影术在技术上是可行的，能够对患者进行快速分诊，以确定胸痛的潜在心脏和非心脏原因。因此，该检查可能有助于显著降低成本和缩短住院时长。需要进行涉及更大患者群体的前瞻性研究来证实这些发现。
