title: [16-MDCT angiography coronary artery in the emergency department for patients with acute coronary syndrome (NSTEMI-UA)].
abstract: 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.
authors.affiliation: Radiologia DEA, Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italia. emanuelecasciani@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Casciani
authors.forename: E
authors.initials: E
authors.lastname: Polettini
authors.forename: L
authors.initials: L
authors.lastname: Bertini
authors.forename: F
authors.initials: F
authors.lastname: Rotolo
authors.forename: G
authors.initials: G
authors.lastname: Truscelli
authors.forename: A
authors.initials: A
authors.lastname: Pittalis
authors.forename: G
authors.initials: G
authors.lastname: Masselli
authors.forename: S
authors.initials: S
authors.lastname: Campagnano
authors.forename: R
authors.initials: R
authors.lastname: Pastore
authors.forename: G F
authors.initials: GF
authors.lastname: Gualdi
mesh_terms: 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
chemical_list: D003287:Contrast Media