Chest pain assessment
The Dual Source CT protocol for chest pain assessment proved to be a helpful tool offering a fast diagnostic workup and patient triage. The heart rate insensitivity of DSCT further increases the diagnostic accuracy of the method by improving coronary artery assessment in acutely ill patients.
The initial symptoms of the individual patient with acute chest pain are often not characteristic. Therefore, various examinations can be necessary to make a diagnosis, which can be very time consuming and expensive. Thus, the initial focus should be to rule out acutely life-threatening conditions including myocardial infarction, aortic dissection and pulmonary embolism.
Simultaneous evaluation of the whole thoracic vasculature by CTA
ECG-gated CT-angiography protocols make a simultaneous assessment of pulmonary arteries, coronary arteries and the aorta feasible within one single breathhold period. Thus, pulmonary embolism, coronary artery disease and aortic aneurysm or dissection can be ruled out in one combined examination. The procedure can help to identify the cause of unclear chest pain or to assign the patient to an appropriate further diagnostic workup.
Limitations of conventional CT scanners
With ECG gating, the acquired images of the coronary arteries should have a similar diagnostic accuracy as a specific coronary CT angiography. However, with conventional CT scanners, a major limitation of this approach especially in acutely ill patients is the restricted image quality in high heart rates. So far, the administration of beta-blockers to lower heart rates is general practice in 16 and 64 slice CT in which coronary CT angiography becomes unreliable in high heart rates. This approach is time consuming and limited by contraindications, and a sufficient reduction of the heart rate cannot be achieved in all patients.
Robust DSCT coronary angiography in high heart rates
Recent studies have shown that Dual Source CT (DSCT) can provide a robust image quality and a very good diagnostic accuracy of coronary CT angiography even in high heart rates (1-4). Thus, DSCT was expected to greatly improve the diagnostic accuracy of the combined CT protocol, and our experience confirms that this assumption was correct. Additionally, a more comprehensive cardiac assessment including wall motion and valvular function is possible with DSCT.
Authors: Thorsten R. C. Johnson, Konstantin Nikolaou, Christoph R. Becker
See corresponding news: Studies confirm reliability of combined protocol for chest pain assessment
See corresponding protocol: Extended chest pain
1 Johnson TR, Nikolaou K, Wintersperger BJ, Leber AW, von Ziegler F, Rist C, Buhmann S, Knez A, Reiser MF, Becker CR (2006) Dual-source CT cardiac imaging: initial experience. Eur Radiol 16:1409-1415
2 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. 2006;16:2739 –2747.
3 Johnson T, Leber AW, Becker A, von Ziegler F, Tittus J, Nikolaou K, Reiser M, Steinbeck G, Becker CR, Knez A (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J
4 Johnson TR, Nikolaou K, Busch S, Leber AW, Becker A, Wintersperger BJ, Rist C, Knez A, Reiser MF, Becker CR (2007) Diagnostic Accuracy of Dual-Source Computed Tomography in the Diagnosis of Coronary Artery Disease. Invest Radiol 42:684-6915
