ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain.
OBJECTIVE
The most important differential diagnoses of acute chest pain include myocardial infarction, aortic dissection, and pulmonary embolism. The purpose of this study was to evaluate the diagnostic value of an ECG-gated 64-MDCT angiography protocol for simultaneous assessment of the pulmonary arteries, coronary arteries, and aorta within a single breath-hold.


METHODS
In 55 patients with acute chest pain, ECG-gated CT angiography was performed with a CT system in which 64 slices per gantry rotation were acquired. Density measurement and visual assessment of motion artifacts were performed to evaluate image quality. CT findings were correlated with results of laboratory tests and clinical follow-up. For 20 patients, two independent blinded reviewers compared findings on CT angiography with those on X-ray coronary angiography.


RESULTS
Adequate contrast enhancement of the pulmonary vessels, coronary arteries, and aorta was achieved in all cases. Regarding image quality of the coronary arteries, there was minor blurring in seven patients, and in one examination the images did not provide enough information for diagnosis. The average image quality rating was 1.2 on a scale in which 1 indicated no artifacts; 2, minor motion artifacts; and 3, image insufficient for diagnosis. The cause of chest pain was correctly identified with MDCT in 37 patients. The diagnoses included pulmonary embolism (n = 10), coronary stenosis (n = 9), and aortic dissection (n = 1). In four patients, additional diagnoses were found with other examinations.


CONCLUSIONS
With current techniques, ECG-gated CT angiography of the entire chest has very good image quality. The protocol proved helpful in the differential diagnosis of acute chest pain.
Johnson
Thorsten R C
TR
Department of Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistrasse 15, 81377 Munich, Germany. thorsten.johnson@med.uni-muenchen.de
Nikolaou
Konstantin
K
Wintersperger
Bernd J
BJ
Knez
Andreas
A
Boekstegers
Peter
P
Reiser
Maximilian F
MF
Becker
Christoph R
CR
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D000792:Angiography / Q000379:methods*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods; D016477:Artifacts; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*