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Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain.

Yoo SM, Rho JY, Lee HY, Song IS, Moon JY, White CS - Korean Circ J (2010)

Bottom Line: This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO).This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination.A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, CHA Medical University Hospital, Seongnam, Korea.

ABSTRACT
This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac CTA (i.e., dedicated coronary CTA versus TRO) to triage patients with nonspecific acute chest pain. This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination. A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

No MeSH data available.


Related in: MedlinePlus

A 67-year-old female patient with a critical coronary artery stenosis (>70%) in a triple rule-out study. A: critical coronary artery stenosis (>70%, arrowheads) with non-calcified plaque is identified at the proximal left circumflex coronary artery on a curved multi-planar reformatted image. B: critical coronary artery stenosis (arrow) is also identified in the same segment on coronary angiography.
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Figure 6: A 67-year-old female patient with a critical coronary artery stenosis (>70%) in a triple rule-out study. A: critical coronary artery stenosis (>70%, arrowheads) with non-calcified plaque is identified at the proximal left circumflex coronary artery on a curved multi-planar reformatted image. B: critical coronary artery stenosis (arrow) is also identified in the same segment on coronary angiography.

Mentions: Immediate coronary angiography is mandatory in patients with acute chest pain and critical coronary artery stenosis (>70%) (Fig. 6). For patients with indeterminate coronary artery stenosis (50-70%) or non-diagnostic coronary CTA caused by coronary motion artifact, severe calcified plaque, or low contrast-noise ratio, radionuclide stress perfusion imaging is a possible option to further triage these patients.25) However, if a patient has a positive result on radionuclide stress perfusion imaging, the total radiation exposure becomes quite high because coronary angiography is generally performed next. This is a drawback in using CT as part of the triage system to evaluate patients with acute chest pain. For this reason, alternative modalities that do not involve radiation exposure, such as stress echocardiography or stress MRI, may be considered to mitigate high radiation exposure in this subgroup of patients with acute chest pain, although there has not been a well-designed study addressing this scenario.


Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain.

Yoo SM, Rho JY, Lee HY, Song IS, Moon JY, White CS - Korean Circ J (2010)

A 67-year-old female patient with a critical coronary artery stenosis (>70%) in a triple rule-out study. A: critical coronary artery stenosis (>70%, arrowheads) with non-calcified plaque is identified at the proximal left circumflex coronary artery on a curved multi-planar reformatted image. B: critical coronary artery stenosis (arrow) is also identified in the same segment on coronary angiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008823&req=5

Figure 6: A 67-year-old female patient with a critical coronary artery stenosis (>70%) in a triple rule-out study. A: critical coronary artery stenosis (>70%, arrowheads) with non-calcified plaque is identified at the proximal left circumflex coronary artery on a curved multi-planar reformatted image. B: critical coronary artery stenosis (arrow) is also identified in the same segment on coronary angiography.
Mentions: Immediate coronary angiography is mandatory in patients with acute chest pain and critical coronary artery stenosis (>70%) (Fig. 6). For patients with indeterminate coronary artery stenosis (50-70%) or non-diagnostic coronary CTA caused by coronary motion artifact, severe calcified plaque, or low contrast-noise ratio, radionuclide stress perfusion imaging is a possible option to further triage these patients.25) However, if a patient has a positive result on radionuclide stress perfusion imaging, the total radiation exposure becomes quite high because coronary angiography is generally performed next. This is a drawback in using CT as part of the triage system to evaluate patients with acute chest pain. For this reason, alternative modalities that do not involve radiation exposure, such as stress echocardiography or stress MRI, may be considered to mitigate high radiation exposure in this subgroup of patients with acute chest pain, although there has not been a well-designed study addressing this scenario.

Bottom Line: This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO).This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination.A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, CHA Medical University Hospital, Seongnam, Korea.

ABSTRACT
This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac CTA (i.e., dedicated coronary CTA versus TRO) to triage patients with nonspecific acute chest pain. This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination. A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

No MeSH data available.


Related in: MedlinePlus