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[Phase analysis of gated blood pool scintigraphy in traumatic myocardial contusion]
1Department of Radiology, Kitasato University School of Medicine.
Insights
Diagnosing myocardial contusion after blunt chest trauma is challenging. Phase analysis of gated blood pool scintigraphy (GBPS) is a useful diagnostic tool, especially when two-dimensional echocardiography (2-D Echo) is not feasible.
Area of Science:
- Cardiology
- Nuclear Medicine
- Emergency Medicine
Background:
- Blunt chest trauma often presents with multiple injuries, complicating myocardial contusion diagnosis.
- Clinical symptoms and electrocardiograms suggest potential myocardial contusion but require further confirmation.
Purpose of the Study:
- To evaluate the diagnostic utility of phase analysis of gated blood pool scintigraphy (GBPS) for myocardial contusion.
- To compare phase analysis of GBPS with other diagnostic methods like 2-D echocardiography (2-D Echo) and biochemical markers.
Main Methods:
- Phase analysis of GBPS was performed on 38 patients with suspected myocardial contusion.
- Results were compared with 2-D Echo, CPK-MB fraction, 201TlCl scintigraphy, and 99mTc-pyrophosphate scintigraphy.
Main Results:
- Phase analysis of GBPS showed agreement with 2-D Echo in 76.3% of patients.
- Phase analysis proved valuable for diagnosing myocardial contusion in patients where 2-D Echo was contraindicated (e.g., pneumothorax).
- Correlation with CPK-MB and 99mTc-pyrophosphate scintigraphy was limited.
Conclusions:
- Phase analysis of GBPS is a valuable tool for diagnosing myocardial contusion following blunt chest trauma.
- It serves as a useful alternative to 2-D Echo, particularly in specific patient populations.
Abstract:
It is not easy to make a diagnosis of myocardial contusion following blunt chest trauma, because most patients have many other concurrent injuries with diverse symptoms. The usefulness of phase analysis of gated blood pool scintigraphy (GBPS) for myocardial contusion following blunt chest trauma was evaluated. Thirty-eight patients who had been strongly suspected of having myocardial contusion from clinical symptoms and electrocardiograms underwent phase analysis of GBPS. The results of phase analysis were compared with those of two-dimensional echocardiography (2-D Echo) and CPK-MB fraction measurement in all patients, with those of 201TlCl myocardial scintigraphy in 35 patients and with those of 99mTc-pyrophosphate scintigraphy in 10 patients. In 29 patients (76.3%), the results of phase analysis matched those of 2-D Echo. Two patients (5.3%) who were judged as positive by 2-D Echo and as negative by phase analysis had only rupture of the chordae. Only one of two other patients who were judged as negative by 2-D Echo and as positive by phase analysis was judged as positive by 201TlCl myocardial scintigraphy. The results of both 2-D Echo and phase analysis were not well correlated with those of CPK-MB fraction measurement and 99mTc pyrophosphate scintigraphy. It is concluded that phase analysis of GBPS, as well as 2-D Echo, is useful for diagnosing myocardial contusion, and that phase analysis is most useful for diagnosing myocardial contusion in patients who cannot be examined by 2-D Echo because of the presence of pneumothorax and/or subcutaneous emphysema in the anterior chest wall.