Myocardial hypoperfusion on conventional contrast computed tomography

The American Journal of Emergency Medicine
Shing Ching, Tak Shun Chung

Abstract

Non–electrocardiogram (ECG)–gated contrast computed tomography (CT) is commonly performed to exclude aortic dissection in chest pain patients. Besides evaluating the aorta for dissection flap, attention should be paid to the myocardium for areas of hypoenhancement that may suggest ischemia. Current models of multidetector CT enable assessment of myocardial perfusion with minimal motion artifact even without ECG gating. Transmural hypoenhancement with preserved wall thickness in a coronary distribution is highly specific for acute myocardial infarction. We report 2 cases of acute chest pain with initial nondiagnostic studies that underwent CT aortogram to exclude dissection. Instead, the CT showed myocardial hypoenhancement in left anterior descending artery territory. Myocardial hypoenhancement occurred before ST-segment elevation on ECG, suggesting that recognition of this important finding may lead to earlier revascularization decisions.

References

May 20, 2004·AJR. American Journal of Roentgenology·Amy GosaliaHugo Spindola-Franco
Jul 7, 2009·Journal of Cardiovascular Computed Tomography·Harvey S Hecht, Tandeep Bhatti

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Citations

Sep 21, 2016·Physical Therapy in Sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine·I J R TakG M M J Kerkhoffs

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