Diagnostic Accuracy of Coronary Artery Occlusion and Myocardial Perfusion Defect on Non-Gated Enhanced Chest CT in Predicting Acute Myocardial Infarction.

Min Ji Son,Seung Min Yoo,Dongjun Lee,Charles S White

doi:10.3390/tomography7040043

Abstract

The purpose of this study was to evaluate the diagnostic accuracy of coronary artery occlusion (CAO) and myocardial perfusion defect (MPD) identified on non-gated enhanced chest CT in patients with acute myocardial infarction (AMI). We retrospectively assessed 99 patients with AMI (group 1, n = 33) and without AMI (group 2, n = 66) who underwent non-gated chest CT. We analyzed the presence of MPD and CAO on non-gated chest CT. MPD on the CT was categorized using a three-point scale (0 = no definite MPD; 1 = probable artifact or questionable MPD; 2 = probable MPD). Presence of CAO was defined as an abrupt change of contrast enhancement in a coronary artery segment with no or minimal coronary motion on the CT. There were 42.4% and 12.1% patients with probable MPD (p = 0.002), and 18.2% and 0% patients with CAO (p = 0.001) in groups 1 and 2, respectively. Probable MPD alone and simultaneous presence of CAO and probable MPD to predict AMI resulted in sensitivity, specificity, negative predictive value, and positive predictive valve of 42.4%, 87.9%, 75.3%, and 63.6%, respectively, and 12.1%, 100%, 69.5%, and 100%, respectively. In conclusion, probable MPD alone on non-gated chest CT demonstrated a relatively low sensitivity, high specificity, and modest positive predictive value for the prediction of AMI on non-gated enhanced chest CT. Although it is rare, simultaneous presence of CAO and probable MPD had a high positive predictive value to predict AMI on non-gated enhanced chest CT.

Highlights

Non-gated enhanced chest CT can be a first-line imaging study in patients who present with nonspecific chest pain, shock, or dyspnea, and who prove to have acute myocardial infarction (AMI) [1]
The presence of a wall motion abnormality leading to reduced motion of the epicardial coronary artery in the culprit arterial territory in patients with AMI may increase the opportunity to identify coronary artery occlusion (CAO), even on non-gated enhanced chest CT
The purpose of this study was to investigate whether presence of probable myocardial perfusion defect (MPD) or CAO with least motion blurring on the non-gated enhanced chest CT have a high specificity to predict AMI or not

Summary

Introduction

Non-gated enhanced chest CT can be a first-line imaging study in patients who present with nonspecific chest pain, shock, or dyspnea, and who prove to have acute myocardial infarction (AMI) [1]. The presence of a wall motion abnormality leading to reduced motion of the epicardial coronary artery in the culprit arterial territory in patients with AMI may increase the opportunity to identify coronary artery occlusion (CAO), even on non-gated enhanced chest CT. In this context, it may be valuable to precisely discriminate true MPD and CAO from the artifacts on the non-gated enhanced chest CT in patients with AMI, while minimizing false positive diagnosis by applying strict criteria on probable MPD and CAO. The purpose of this study was to investigate whether presence of probable MPD or CAO with least motion blurring on the non-gated enhanced chest CT have a high specificity to predict AMI or not

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