Diagnostic accuracy of myocardial hypoenhancement on multidetector computed tomography in identifying myocardial infarction in patients admitted with acute chest pain syndrome.
OBJECTIVE
To evaluate prevalence and diagnostic accuracy of myocardial hypoenhancement (MH) using multidetector computed tomography (MDCT) in patients admitted for acute chest pain syndromes.


METHODS
Sixty-nine patients underwent first-pass MDCT, coronary angiography, and echocardiography. Using a standardized analysis protocol, left ventricular short-axis reformations were evaluated for presence, size, and density of MH in 16 myocardial segments. These were correlated with the presence and location of myocardial infarction (MI), regional myocardial dysfunction, and coronary artery disease.


RESULTS
Myocardial hypoenhancement was found in acute MI (27/35), healed MI (6/14), unstable angina (3/9), and atypical chest pain (0/11). Sensitivity, specificity, and positive and negative predictive values of MH for diagnosing any MI were 67%, 85%, 92% and 52%, respectively.


CONCLUSIONS
The presence of MH on MDCT in acute chest pain patients has high positive predictive value and specificity but only moderate sensitivity for presence of acute or healed MI using the strict criteria proposed in this study.
Lessick
Jonathan
J
Cardiology Department, Rambam Medical Center and Technion-IIT, Haifa, Israel. j_lessick@rambam.health.gov.il
Ghersin
Eduard
E
Dragu
Robert
R
Litmanovich
Diana
D
Mutlak
Diab
D
Rispler
Shmuel
S
Agmon
Yoram
Y
Engel
Ahuva
A
Beyar
Rafael
R
D000208:Acute Disease; D000704:Analysis of Variance; D002637:Chest Pain / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide