Akut Göğüs Ağrısı ile Acil Servise Başvuran Hastaların Çift Tüplü Bilgisayarlı Tomografi Cihazı ile Triple Rule-out Tomografi Anjiografilerinin Değerlendirilmesi

Öz

Amaç: Bu çalışmada tek bir çekimle, kısa sürede göğüs ağrısına sebep olabilecek koroner, aortik ya da pulmoner sebeplerin saptanmasında Triple rule-out (TRO) tomografik anjiyografi tekniği uygulanarak, çift tüplü bilgisayarlı tomografi (dual source computerise tomography, çift tüplü bilgisayarlı tomografi, ÇTBT) incelemelerinin etkinliğini ve olası kısıtlılıklarını değerlendirmeyi amaçladık.

Materyal ve Metod: Çalışmaya Ekim 2011-Kasım 2012 tarihleri arasında akut göğüs ağrısı ile acile başvuran, akut koroner sendrom (AKS), akut pulmoner tromboemboli (PTE) ve aort diseksiyonundan en az biri ön tanı olarak düşünülen TRO tekniği uygulanarak ÇTBT çekimi uygulanmış olan 154 hasta (102 erkek, 52 kadın; yaş ortalaması: 58,21±13.22) dahil edildi.  Hastalara ait görüntülerde axiyel kesitler, multi-planar reformat (MPR), curved MPR, maximum intensity projeksiyon (MIP) ve volume rendering (VR) imajlar kullanılarak değerlendirme yapıldı.

Bulgular: 154 hastanın 108 (%70,12)'inde koroner arterlerin incelenmesi neticesinde koroner arter hastalığı (KAH) tespit edildi. Bu 108 hastanın ise 36 (%23,37)'sında hafif, 42 (%27,27)'sinde orta ve 30 (%19,48)'unda ileri derecede KAH mevcuttu. Bunun yanında hastaların 21 (%13,63)'inde PTE saptandı. Hastaların 8(%5,1)'inde aort diseksiyonu, 1 (%0,6)'inde ise aort koarktasyonu bulundu.

Sonuç: TRO-ÇTBT, kısa çekim süresi ve tek bir çekimle çok sayıda patolojinin ekartasyonunu sağlayan, erken tanı ve tedavi ile gereksiz maliyetleri ortadan kaldıran güvenilir non-invaziv bir tanı yöntemidir.

Anahtar Kelimeler

• triple rule-out,bilgisayarlı tomografik anjiografi,çift tüplü bilgisayarlı tomografi,akut göğüs ağrısı

Kaynakça

1. 1. Erhardt L, Herlitz J, Bossaert L et al. Task force on the management of chest pain. Eur Heart J, 2002, 23:1153–1176.
2. 2. Karlson BW, Herlitz J, Pettersson P et al. Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med,1991 230:251–258.
3. 3. Zimmerman J, Fromm R, Meyer D et al. Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation,1999, 99:1671–1677.
4. 4. Yoo SM, Rho JY, Lee HY, Song IS, Moon JY, White CS. Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain. Korean Circ J 2010; 40: 543-9.
5. 5. Halpern EJ. Clinical applications of cardiac CT angiography. Insights Imaging 2010; 1: 205-22.
6. 6. Schertler T, Scheffel H, Frauenfelder T, Desbiolles L, Leschka S, Stolzmann P, et al. Dual-source computed tomography in patients with acute chest pain: feasibility and image quality. Eur Radiol 2007; 17: 3179-88.
7. 7. George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM, Lardo AC, et al. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography with obstructive coronary artery disease. Circ Cardiovasc Imaging 2012; 5: 333-40.
8. 8. Akpınar E, Hızal M. Akut Göğüs Ağrısında Üçlü Dışlama Bilgisayarlı Tomografi Anjiyografi. Trd Sem 2013;1:143-152.

9. 9. Schussler JM, Smith ER. Sixty-four-slice computed tomographic coronary angiography: will the “triple rule out” change chest pain evaluation in the ED? Am J Emerg Med 2007; 25:367–375.
10. 10. Hoffmann U, Pena AJ, Moselewski F, et al. MDCT in early triage of patients with acute chest pain. AJR 2006; 187:1240–1247.
11. 11. Hoffmann U, Nagurney JT, Moselewski F, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 2006; 114:2251–2260.
12. 12. Rubinshtein R, Halon DA, Gaspar T, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation 2007; 115:1762–1768.
13. 13. Ledbetter S, Stuk JL, Kaufman JA. Helical (spiral) CT in the evaluation of emergent thoracic aortic syndromes. Traumatic aortic rupture, aortic aneurysm, aortic dissection, ıntramural hematoma, and penetrating atherosclerotic ulcer. Radiol Clin North Am 1999; 37: 575-89.
14. 14. Kim SY, Seo JB, Do KH, Heo JN, Lee JS, Song JW, et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 2006; 26: 317-34.
15. 15. Sato Y, Matsumoto N, Ichikawa M, Kunimasa T, Lida K, Yoda S, et al. Efficacy of multislice computed tomography for the detection of acute coronary syndrome in the emergency department. Circ J 2005; 69: 1047-51.
16. 16. Savino G, Herzog C, Costello P, Schoepf UJ. 64 slice cardiovascular CT in the emergency department: concepts and first experiences. Radiol Med 2006;111:481-96.
17. 17. Takakuwa KM, Halpern EJ. Evaluation of a “triple rule-out” coronary CT angiography protocol: use of 64-section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. Radiology 2008; 248: 438-46.
18. 18. Mori S, Endo M, Nishizawa K, Murase K, Fujiwara H, Tanada S. Comparison of patient doses in 256-slice CT and 16-slice CT scanners. Br J Radiol 2006;79: 56-6.
19. 19. Betsou S, Efstathopoulos EP, Katritsis D et al. Patient radiation doses during cardiac catheterization procedures. Br J Radiol.1998;71:634-639.
20. 20. Dewey M, Zimmermann E, Deissenrieder F et al. Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 2009; 120:867-875.
21. 21. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA 2009; 301:500-5.
22. 22. Primak AN, Mc Collough CH, Bruesewitz MR, Zhang J, Fletcher JG, Relationships between noise, dose, and pitch in cardiac multislice row CT. Radiographics 2006; 26(6): 1785-1794.
23. 23. Jeudy J, White C. Evaluation of the acute chest pain in the emergency department: utility of multidedector CT. Semin Ultrasound CT MR 2007; 28: 109-14.
24. 24. Sommer WH, Schenzle JC, Becker CR, Nikolaou K, Graser A, Michalski G, et al. Saving dose in triple-rule-out computed tomography examination using high-pitch dual spiral technique. Invest Radiol 2010; 45: 64-71.
25. 25. Sun Z. Multislice CT angiography in coronary artery disease: Technical developments, radiation dose and diagnostic value World J Cardiol 2010; 26;2(10):333-343.