Higashigaito Kai, Hinzpeter Ricarda, Baumueller Stephan, Benz David, Manka Robert, Keller Dagmar I, Alkadhi Hatem, Morsbach Fabian
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.
Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland.
Eur J Radiol Open. 2018 Nov 10;5:202-208. doi: 10.1016/j.ejro.2018.10.001. eCollection 2018.
To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED).
In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CT, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CT, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium.
HM was identified in 27/300 patients (9%): 12/179 in chest-pain CT (7%) and 15/121 in chest-pain CT (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients' history. Chest-pain CT identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI.
HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CT when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.
评估急诊科（ED）胸痛CT检查患者中低密度心肌（HM）出现的频率及相关性。
在这项经机构审查委员会（IRB）批准的回顾性研究中，对我院ED连续300例（平均年龄60±17岁）因急性胸痛就诊患者的心电图门控胸痛CT检查进行评估。一旦排除ST段抬高型梗死，进行包括冠状动脉的胸痛CT检查（排除急性冠状动脉综合征（ACS）、肺栓塞（PE）和急性主动脉综合征（AAS）：胸痛CT，n = 121）或不包括冠状动脉的胸痛CT检查（排除PE和AAS：胸痛CT，n = 179）。评估每个心肌节段是否存在HM；测量其衰减并与正常心肌进行比较。
300例患者中有27例（9%）发现HM：胸痛CT（不包括冠状动脉）组179例中有12例（7%），胸痛CT（包括冠状动脉）组121例中有15例（12%）。HM的平均衰减（40±17 HU）显著低于健康心肌（103±18 HU，p < 0.001），平均差值为61±19 HU。27例有HM的患者中，15例（55.6%）最终诊断为急性心肌梗死（MI），其余12例（44.4%）患者既往有MI病史。最终诊断为急性MI的15例患者中，胸痛CT发现HM的有10例（66.6%）。
在ED的胸痛CT检查中，常可发现提示急性MI的HM，即使在未怀疑MI的胸痛CT检查中也是如此。这表明即使未怀疑MI，也应始终分析心肌有无低密度区域。
