title: Acute coronary syndrome: evaluation of detection capability using non-electrocardiogram-gated parenchymal phase CT imaging.
abstract: OBJECTIVE
  To evaluate the capability to detect acute coronary syndrome (ACS) by using non-electrocardiogram-gated parenchymal phase CT imaging.
  
  
  METHODS
  Of 962 consecutive patients who underwent emergent coronary angiography for suspected ACS, 32 with ACS who underwent CT ≤24 h before angiography and 15 without ACS who underwent CT ≤24 h before or after angiography were included. Parenchymal phase was acquired at 100-s scan delay. The presence of a myocardial perfusion defect (MPD) on the left ventricle (a decrease of >20 HU) and its capability to detect ACS were evaluated. Results were compared with laboratory findings.
  
  
  RESULTS
  MPD was detected in 29 of 32 ACSs. The sensitivity, specificity, and positive and negative predictive values were 91 % (29/32), 93 % (14/15), 97 % (29/30), and 82 % (14/17), respectively. The sensitivities of ST- and non-ST-elevation ACSs were 89 % (16/18) and 93 % (13/14), respectively, without significant difference (P > 0.99). Of the CT-detectable ACS, non-ST-elevation on the electrocardiogram and a normal creatine kinase-myocardial band were observed in 41 % (12/29) and 24 % (7/29), respectively.
  
  
  CONCLUSIONS
  ACS is highly detectable even using conventional parenchymal phase CT imaging. Therefore, even when CT is non-gating, radiologists should carefully evaluate the heart to avoid overlooking ACS.
authors.affiliation: Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuou-ku, Niigata, Japan. xackey2001@gmail.com.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Yamazaki
authors.affiliation: Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuou-ku, Niigata, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Higuchi
authors.affiliation: Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuou-ku, Niigata, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Shimokoshi
authors.affiliation: Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Shumoku, Chuou-ku, Niigata, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kiguchi
authors.affiliation: Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuou-ku, Niigata, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Horii
authors.affiliation: Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuou-ku, Niigata, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuou-ku, Niigata, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Aoyama
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Acute coronary syndrome; Acute myocardial infarction; Coronary CT angiography; Myocardial perfusion defect; Non-ECG-gated CT