[16-MDCT angiography coronary artery in the emergency department for patients with acute coronary syndrome (NSTEMI-UA)].
OBJECTIVE
The diagnosis of acute coronary syndrome (ACS), non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) remains a challenge. The aim of our study was to investigate quality and the diagnostic accuracy of 16-MDCT coronary angiography, detecting coronary artery lesions in patients with suspected ACS presented in ED.


METHODS
We studied with 16-MDCT (Sensation 16, Siemens, Forchleim, Germania) and coronary angiography 37 patients with the following inclusion criteria: chest pain compatible with myocardial ischemia, normal or no-diagnostic ECG changes and initial concentrations of serum troponin-I < or =1 ng/ml. The 16-MDCT was performed with ECG-gated technique after the intravenous administration of 90-100 ml of iodinated contrast material followed by a saline bolus. The scan parameters were: 120 kV, 650-720 mAs, 16 x 0.75mm collimation, 0.42s rotation time, 3 mm (pitch 0.25) feed/rot, B30f kernel. We evaluated for each patient: image quality and different artefacts, plaques identification and characterization.


RESULTS
The evaluation of the image quality was based on a total of 453 segments, of which 415 segments (92.2%) were considered to have diagnostic image quality. MDCT correctly detected 15 patients with at least 1 stenosis >50% and correctly ruled out significant coronary artery disease in 19 patients with 1 FP and 2 FN: sensitivity 88%, specificity 95%, PPV 94%, NPV 90%. The plaques were hard in 6 cases, mixt in 16 cases and soft in 14 cases, respectively.


CONCLUSIONS
Our results point-out that 16-MDCT in ED has the real ability to detect and rule out significant coronary stenoses in patients with ACS.
Casciani
E
E
Radiologia DEA, Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italia. emanuelecasciani@hotmail.com
Polettini
E
E
Bertini
L
L
Rotolo
F
F
Truscelli
G
G
Pittalis
A
A
Masselli
G
G
Campagnano
S
S
Pastore
R
R
Gualdi
G F
GF
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000494:pharmacology; D017023:Coronary Angiography / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
D003287:Contrast Media