title: Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography.
abstract: OBJECTIVE
  To prospectively evaluate the enhancement of coronary, pulmonary, and thoracic aortic vasculature by using biphasic single-acquisition 64-section computed tomographic (CT) angiography and to prospectively evaluate if differences in right side of the heart and coronary venous enhancement interfere with interpretation of coronary arteries.
  
  
  METHODS
  With internal review board approval and HIPAA compliance, 50 patients (16 men, 34 women; mean age, 51.5 years; range, 30-75 years) with atypical chest pain were referred from the emergency department and were imaged with a 64-section CT scanner after premedication with oral atenolol and/or intravenous metoprolol. Thoracic CT angiography with retrospective gating was subsequently performed with a single biphasic injection of 130 mL of iso-osmolar contrast material (100 mL at 5 mL/sec and 30 mL at 3 mL/sec) in caudal-to-cranial acquisition. Coronary, aortic, and pulmonary arterial attenuation values were obtained. Coronary venous and right atrial enhancement were evaluated to assess whether there was interference with coronary artery evaluation. A two-tailed Friedman test was used to evaluate differences among segments within each artery.
  
  
  RESULTS
  Mean coronary arterial, pulmonary arterial, and aortic attenuation values were significantly higher than the 250-HU threshold (P < .05). Mean pooled coronary arterial (288.9 HU +/- 64.8), pulmonary arterial (316.4 HU +/- 79.9), and aortic (329.9 HU +/- 63.3) attenuation values were significantly higher than the 250-HU threshold (P < .0001). Coronary venous enhancement did not affect depiction or interpretation of coronary arteries. Right atrial streak artifact focally traversed the right coronary artery in only one study.
  
  
  CONCLUSIONS
  The aforementioned thoracic CT angiographic protocol provides enhancement of coronary, aortic, and pulmonary vasculature in a single breath hold without interference from right side of the heart streak artifact or coronary venous enhancement.
authors.affiliation: Department of Radiology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Vrachliotis
authors.forename: Kostaki G
authors.initials: KG
authors.lastname: Bis
authors.forename: Ahmad
authors.initials: A
authors.lastname: Haidary
authors.forename: Rajani
authors.initials: R
authors.lastname: Kosuri
authors.forename: Mamtha
authors.initials: M
authors.lastname: Balasubramaniam
authors.forename: Michael
authors.initials: M
authors.lastname: Gallagher
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.forename: Michael
authors.initials: M
authors.lastname: Ross
authors.forename: Brian
authors.initials: B
authors.lastname: O'neil
authors.forename: William
authors.initials: W
authors.lastname: O'neill
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001027:Aortography / Q000379:methods*; D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*