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The "cardiac neglect": a gentle reminder to radiologists interpreting contrast-enhanced abdominal MDCT

Emina Talakić1, Helmut Schöllnast1,2, Ann-Katrin Kaufmann-Bühler3

  • 1Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.

Frontiers in Cardiovascular Medicine
|May 14, 2023
PubMed

Insights

Myocardial infarction (MI) is often missed on abdominal CT scans, with only 11% of cases noted in reports. This study highlights the need for increased awareness of detectable MI on abdominal MDCTs to prevent missed diagnoses.

Area of Science:

  • Radiology
  • Cardiology
  • Medical Imaging

Background:

  • Myocardial infarction (MI) can be incidentally detected on contrast-enhanced multidetector computed tomography (MDCT) abdominal scans.
  • Previously, missed MI on abdominal MDCTs was not considered a significant issue in radiological practice.

Purpose of the Study:

  • To assess the frequency of detectable myocardial hypoperfusion on contrast-enhanced abdominal MDCTs.
  • To evaluate the radiological reporting of incidental MI findings on abdominal MDCTs.

Main Methods:

  • Retrospective single-center study of patients who underwent abdominal MDCTs.
  • Inclusion criteria: abdominal MDCTs within 24 hours of catheter-proven or clinically evident MI diagnosis.
  • Review of 38 patient records and MDCTs (non-ECG-gated) for signs of myocardial hypoperfusion.

Main Results:

  • 19 out of 38 (50%) patients showed areas of myocardial hypoperfusion on abdominal MDCTs.
  • Only 2 of 19 (11%) cases of myocardial hypoperfusion were documented in radiology reports.
  • ST-elevation MI (STEMI) was more frequent in patients with detectable hypoperfusion (p ).
  • 42% of patients with detectable hypoperfusion died due to acute MI.

Conclusions:

  • Myocardial hypoperfusion is frequently detectable on non-ECG-gated abdominal MDCTs.
  • There is a significant underreporting of incidental MI findings on abdominal MDCTs.
  • Increased radiologist awareness is crucial to reduce missed MI diagnoses, potentially preventing thousands of missed cases globally each year.
Keywords:
abdomenabdominal paincontrast mediadiagnostic imagingmissed diagnosismultidetector computed tomographymyocardial infarction

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