ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain
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The purpose of this study was to evaluate chest CTA protocol using retrospective ECG-gating and triphasic IV contrast regimen for comprehensive evaluation of patients with acute non-specific chest pain. ECG-triggered dose modulation was used with a 64-MDCT scanner in 56 non-critically ill patients with acute nonspecific chest pain using triphasic IV regimen: 50 ml contrast followed by 50 ml 60% contrast/saline and 30 ml normal saline. Lungs, aorta, pulmonary and coronary arteries were graded on a 5-point scale (5, best). Aorta and pulmonary artery attenuation was measured and three coronary artery groups were evaluated. Comparison with invasive coronary angiography was obtained in nine patients on a per segment (16 total) basis. Dosimetry values were obtained. Studies were satisfactory in all patients (score >3). Aorta and pulmonary artery attenuation was >200 HU in 90.5%. Lung or pleura, non-cardiac vascular and coronary arteries disease were detected in 20, 11 and 16 patients, respectively. Median coronary angiography (grade 5) was significantly higher than acceptable for diagnosis grade 4 (p < 0.001). Per segment, weighted kappa statistic was 0.79 indicating substantial agreement with catheter angiography (p<0.001). Average DLP was 1,490 ± 412 mGy-cm. Gated 64-MDCT angiography with triphasic IV contrast is a robust multipurpose technique for patients with acute non-specific chest pain.
KeywordsComputed tomography Coronary arteries ECG-gated chest CT Acute chest pain Emergency department
The authors are grateful to (Donna Wolfe) for editorial assistance and to (Clotell Forde) for secretarial, data formatting and literature search assistance and (Iryna Rastorhuyeva) for assistance with data collection.
- 12.Vrachliotis TG, Bis KG, Haidary A, Kosuri R, Balasubramaniam M, Gallagher M, Raff G, Ross M, O’neil B, O’neill W (2007) Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement atbiphasic single-injection 64-section CT angiography. Radiology 243(2):368–376, MayPubMedCrossRefGoogle Scholar
- 14.Austen W, Edwards J, Frye R et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association 51(4 Suppl):5–40, AprGoogle Scholar
- 15.European Guidelines on Quality Criteria for Computed Tomography. Available at: http://www.drs.dk/guidelines/ct/quality/index.htm. Accessed June 26, 2002
- 16.White CS, Kuo D, Kelemen M. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR 185:533–540Google Scholar
- 17.Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, Wintersperger B, Reiser M, Becker CR, Steinbeck G, Boekstegers P (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46(1):147–154PubMedCrossRefGoogle Scholar
- 19.Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Suss C, Grasruck M, Stierstorfer K, Krauss B, Raupach R, Primak AN, Kuttner A, Achenbach S, Becker C, Kopp A, Ohnesorge BM (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16(2):256–68, Feb, Epub 2005 Dec 10. Erratum in: Eur Radiol 16(6):1405, JunPubMedCrossRefGoogle Scholar
- 20.Scheffel H, Alkadhi H, Plass A, Vachenauer R, Desbiolles L, Gaemperli O, Schepis T, Frauenfelder T, Schertler T, Husmann L, Grunenfelder J, Genoni M, Kaufmann PA, Marincek B, Leschka S (2006) Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control. Eur Radiol 16(12):2739–2747, DecPubMedCrossRefGoogle Scholar