Journal of cardiovascular computed tomography
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J Cardiovasc Comput Tomogr · Mar 2009
ReviewIs the "triple rule-out" study an appropriate indication for cardiovascular CT?
There is interest in using the fast volume coverage of 64-slice cardiovascular CT angiography (CCTA) in patients presenting with undifferentiated acute chest pain to simultaneously evaluate the coronary arteries, thoracic aorta, and pulmonary arteries during a single breathhold, the so-called "triple rule-out." However, it is not clear whether the triple rule-out study is an appropriate indication for cardiovascular CCTA. Initial studies suggest that performing a triple rule-out protocol to comprehensively evaluate patients with acute chest pain presenting to the emergency department (ED) is feasible and that quantitative parameters of image quality may be comparable to the conventional, dedicated coronary and pulmonary CTA protocols. ⋯ In addition, new scanner technology has also reduced the contrast and radiation doses necessary for such an examination. However, despite these early encouraging results, randomized control trials designed to determine whether this protocol is safe, cost-effective, and improves clinical decision making are necessary before routine implementation of such an examination can be justified.
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J Cardiovasc Comput Tomogr · Jan 2009
ReviewRole of computed tomography in the evaluation of acute chest pain.
Chest pain is common and the initial clinical presentation is often nonspecific. The emergency physician faces the challenge of correctly identifying those patients with a life-threatening cause of chest pain while avoiding unnecessary hospital admissions. Three important life-threatening causes of chest pain are aortic dissection, pulmonary embolism, and acute coronary syndrome. ⋯ Improvements in CT scanner technology now enable in-depth data on the coronary arteries. Although angiographic information is limited in its relation to physiologic lesion significance, coronary CT is used to safely diagnose or exclude coronary disease as a source of chest pain in emergency department patients. "Triple rule-out" protocols designed to simultaneously assess the aorta, pulmonary arteries, and coronary arteries are a compromise between dedicated protocols for each diagnosis. The diagnostic value and appropriate clinical use of these protocols remain to be shown by randomized, controlled, outcomes-based trials.
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J Cardiovasc Comput Tomogr · Sep 2008
Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease.
Dilatation of the aortic root and other segments of the thoracic aorta is important in the pathogenesis of aortic regurgitation and of aortic dissection. Although echocardiographic criteria exist to detect aortic root dilation, comparably standardized methods have not been developed to detect enlargement of the remainder of the thoracic aorta. Nongated axial chest computed tomography (CT), traditionally used to evaluate aortic size, does not account for the obliquity, systolic expansion, and nonaxial motion of the aorta during the cardiac cycle. Reference values for aortic diameters in anatomically correct double-oblique short axis images have not been established with the use of electrocardiogram (ECG)-gated 64-detector row multidetector CT (MDCT). ⋯ This study establishes age- and sex-specific ECG-gated MDCT reference values for thoracic aortic diameters in healthy, normotensive, nonobese adults to identify aortic pathology by MDCT. MDCT measurements of the thoracic aorta should use ECG-gated double-oblique short-axis images for accurate quantification.
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J Cardiovasc Comput Tomogr · Jul 2008
Case ReportsInflammatory aortitis with coronary arterial involvement by multidetector cardiac computed tomography.
A 40-year-old man with a history of hypertension was admitted for a non-ST-segment myocardial infarction. A multidetector coronary computed tomography (MDCCT) showed proximal aortic intramural thickening with extrinsic thickening and luminal compression of the proximal left circumflex coronary artery. Subsequent surgical evaluation and positron emission tomography imaging showed evidence of active inflammation of the proximal aorta and coronary arteries. Hence, this case illustrates an uncommon cause of myocardial ischemia and the emerging complimentary role that MDCCT can play in such patients.
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J Cardiovasc Comput Tomogr · Mar 2008
Comparative StudyPrognosis by coronary computed tomographic angiography: matched comparison with myocardial perfusion single-photon emission computed tomography.
The diagnostic accuracy of coronary computed tomographic angiography (CTA) is high with few reports noting its ability to stratify risk. The quantity and quality of prognostic evidence with myocardial perfusion single-photon emission computed tomography (SPECT) (MPS) is diverse, with little comparative evidence between methods. The aim of this report was to compare all-cause death rates for 7 CTA subsets, using the Duke prognostic index, compared with percentage of ischemic myocardium by MPS. ⋯ A directly proportional relation was observed between the extent and severity of MPS ischemia and angiographic CAD. High-risk ischemia is more often associated with extensive CAD and high mortality risk. The results from this matched, observational study require additional validation for longer-term predictive models that include major adverse cardiovascular events and diverse patient subsets.