title: ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain.
abstract: 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.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. dlitmano@bidmc.harvard.edu
authors.forename: Diana
authors.initials: D
authors.lastname: Litmanovich
authors.forename: Diana
authors.initials: D
authors.lastname: Litmanovitch
authors.forename: Giulia A
authors.initials: GA
authors.lastname: Zamboni
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hauser
authors.forename: Pei-Jan P
authors.initials: PJ
authors.lastname: Lin
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.forename: Vassilios
authors.initials: V
authors.lastname: Raptopoulos
mesh_terms: D000208:Acute Disease; D001027:Aortography / Q000379:methods; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000175:diagnosis; D008875:Middle Aged; D015588:Observer Variation; D010995:Pleural Diseases / Q000175:diagnosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011856:Radiographic Image Enhancement / Q000379:methods*; D012965:Sodium Chloride / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids; D014652:Vascular Diseases / Q000175:diagnosis
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D012965:Sodium Chloride; C054871:ioversol