SPECT/CT MPI Rest and Stress Single-photon emission computed tomography (SPECT) may be used to assess myocardial function, perfusion, and viability in the trauma setting. The literature for use of SPECT is contradictory. In a prospective study involving 125 patients that evaluated the use of T1-201 thallous chloride SPECT in blunt chest trauma [49], the authors found that 11 out of 75 patients who screened positive and 3 out of 48 patients who screened negative developed serious arrhythmias such as premature ventricular beats and atrial fibrillation. They concluded that SPECT is useful to evaluate myocardial contusion in patients with blunt chest trauma. A meta-analysis study showed that radionuclide results did not correlate with cardiac complications whereas ECG abnormalities and cardiac troponins did in patients with blunt chest trauma [37]. This could be explained by the fact that SPECT better detects left ventricular abnormalities than right ventricular abnormalities, which are more common in blunt cardiac trauma. SPECT/CT MPI Rest Only There is no relevant literature regarding the use of SPECT/CT MPI rest only to evaluate suspected cardiac injuries. Blunt Chest Trauma-Suspected Cardiac Injury US Echocardiography Transesophageal Transesophageal echocardiography (TEE) can be used in the trauma setting; however, it is often time limited because of the hemodynamic instability of the patients, need for sedation, and concern about esophageal injury. TEE is of value when the TTE findings are equivocal and aortic injury is suspected [50]. In a prospective study of 105 patients with severe blunt chest trauma, 20 patients underwent TEE because of suboptimal TTE findings, 9 of whom were diagnosed with a myocardial contusion and 5 with acute aortic injury [50]. TEE is also useful in evaluating right heart and tricuspid valve [51]. There is no evidence to support the use of TEE in the trauma setting for isolated cardiac injury.
Blunt Chest Trauma Suspected Cardiac Injury. SPECT/CT MPI Rest and Stress Single-photon emission computed tomography (SPECT) may be used to assess myocardial function, perfusion, and viability in the trauma setting. The literature for use of SPECT is contradictory. In a prospective study involving 125 patients that evaluated the use of T1-201 thallous chloride SPECT in blunt chest trauma [49], the authors found that 11 out of 75 patients who screened positive and 3 out of 48 patients who screened negative developed serious arrhythmias such as premature ventricular beats and atrial fibrillation. They concluded that SPECT is useful to evaluate myocardial contusion in patients with blunt chest trauma. A meta-analysis study showed that radionuclide results did not correlate with cardiac complications whereas ECG abnormalities and cardiac troponins did in patients with blunt chest trauma [37]. This could be explained by the fact that SPECT better detects left ventricular abnormalities than right ventricular abnormalities, which are more common in blunt cardiac trauma. SPECT/CT MPI Rest Only There is no relevant literature regarding the use of SPECT/CT MPI rest only to evaluate suspected cardiac injuries. Blunt Chest Trauma-Suspected Cardiac Injury US Echocardiography Transesophageal Transesophageal echocardiography (TEE) can be used in the trauma setting; however, it is often time limited because of the hemodynamic instability of the patients, need for sedation, and concern about esophageal injury. TEE is of value when the TTE findings are equivocal and aortic injury is suspected [50]. In a prospective study of 105 patients with severe blunt chest trauma, 20 patients underwent TEE because of suboptimal TTE findings, 9 of whom were diagnosed with a myocardial contusion and 5 with acute aortic injury [50]. TEE is also useful in evaluating right heart and tricuspid valve [51]. There is no evidence to support the use of TEE in the trauma setting for isolated cardiac injury.