Emergency cardiac CT for suspected acute coronary syndrome

Qualitative and quantitative assessment of coronary, pulmonary, and aortic image quality

Jonathan D. Dodd, Sanjeeva Kalva, Antonio Pena, Fabien Bamberg, Michael D. Shapiro, Suhny Abbara, Ricardo C. Cury, Thomas J. Brady, Udo Hoffmann

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation. MATERIALS AND METHODS. Dedicated coronary 64-MDCT data sets of 50 patients (27 men; mean age, 54 ± 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary arteries and aorta. RESULTS. Coronary image quality was excellent in 48 patients (96%) and moderate in two patients (4%). Eleven left main and 22 left upper lobar pulmonary arteries were not visualized. Qualitative evaluation showed pulmonary arterial tree opacification to be excellent except for the right and left lower lateral and posterior segmental branches (52-54% rate of poor opacification). Quantitative evaluation showed four central (8%), six lobar (8%), and 206 segmental (29%) branches had poor contrast opacification (< 200 HU). Nineteen right upper lobar arteries (38%) were slightly and one was severely affected by streak artifact. At the segmental pulmonary artery level, marked differences in contrast enhancement were detected between the upper (292 ± 72 HU) and both the middle (249 ± 85 HU) and the lower lobes (248 ± 76 HU) (p < 0.01). Mean aortic opacification was 300 ± 34 HU with excellent contrast homogeneity without severe motion or streak artifacts. CONCLUSION. In the evaluation of patients presenting to the emergency department with suspected acute coronary syndrome, a dedicated coronary CT protocol enables excellent assessment of the coronary arteries and proximal ascending aorta but does not depict the pulmonary vasculature well enough for exclusion of pulmonary embolism.

Original languageEnglish (US)
Pages (from-to)870-877
Number of pages8
JournalAmerican Journal of Roentgenology
Volume191
Issue number3
DOIs
StatePublished - Sep 2008

Fingerprint

Acute Coronary Syndrome
Artifacts
Emergencies
Pulmonary Artery
Lung
Aorta
Hospital Emergency Service
Pulmonary Circulation
Pulmonary Embolism
Coronary Vessels
Arteries
CT protocol

Keywords

  • Aortic disease
  • Chest pain
  • Coronary angiography
  • CT
  • Pulmonary embolism
  • Radiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Emergency cardiac CT for suspected acute coronary syndrome : Qualitative and quantitative assessment of coronary, pulmonary, and aortic image quality. / Dodd, Jonathan D.; Kalva, Sanjeeva; Pena, Antonio; Bamberg, Fabien; Shapiro, Michael D.; Abbara, Suhny; Cury, Ricardo C.; Brady, Thomas J.; Hoffmann, Udo.

In: American Journal of Roentgenology, Vol. 191, No. 3, 09.2008, p. 870-877.

Research output: Contribution to journalArticle

Dodd, Jonathan D. ; Kalva, Sanjeeva ; Pena, Antonio ; Bamberg, Fabien ; Shapiro, Michael D. ; Abbara, Suhny ; Cury, Ricardo C. ; Brady, Thomas J. ; Hoffmann, Udo. / Emergency cardiac CT for suspected acute coronary syndrome : Qualitative and quantitative assessment of coronary, pulmonary, and aortic image quality. In: American Journal of Roentgenology. 2008 ; Vol. 191, No. 3. pp. 870-877.
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abstract = "OBJECTIVE. The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation. MATERIALS AND METHODS. Dedicated coronary 64-MDCT data sets of 50 patients (27 men; mean age, 54 ± 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary arteries and aorta. RESULTS. Coronary image quality was excellent in 48 patients (96{\%}) and moderate in two patients (4{\%}). Eleven left main and 22 left upper lobar pulmonary arteries were not visualized. Qualitative evaluation showed pulmonary arterial tree opacification to be excellent except for the right and left lower lateral and posterior segmental branches (52-54{\%} rate of poor opacification). Quantitative evaluation showed four central (8{\%}), six lobar (8{\%}), and 206 segmental (29{\%}) branches had poor contrast opacification (< 200 HU). Nineteen right upper lobar arteries (38{\%}) were slightly and one was severely affected by streak artifact. At the segmental pulmonary artery level, marked differences in contrast enhancement were detected between the upper (292 ± 72 HU) and both the middle (249 ± 85 HU) and the lower lobes (248 ± 76 HU) (p < 0.01). Mean aortic opacification was 300 ± 34 HU with excellent contrast homogeneity without severe motion or streak artifacts. CONCLUSION. In the evaluation of patients presenting to the emergency department with suspected acute coronary syndrome, a dedicated coronary CT protocol enables excellent assessment of the coronary arteries and proximal ascending aorta but does not depict the pulmonary vasculature well enough for exclusion of pulmonary embolism.",
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T1 - Emergency cardiac CT for suspected acute coronary syndrome

T2 - Qualitative and quantitative assessment of coronary, pulmonary, and aortic image quality

AU - Dodd, Jonathan D.

AU - Kalva, Sanjeeva

AU - Pena, Antonio

AU - Bamberg, Fabien

AU - Shapiro, Michael D.

AU - Abbara, Suhny

AU - Cury, Ricardo C.

AU - Brady, Thomas J.

AU - Hoffmann, Udo

PY - 2008/9

Y1 - 2008/9

N2 - OBJECTIVE. The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation. MATERIALS AND METHODS. Dedicated coronary 64-MDCT data sets of 50 patients (27 men; mean age, 54 ± 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary arteries and aorta. RESULTS. Coronary image quality was excellent in 48 patients (96%) and moderate in two patients (4%). Eleven left main and 22 left upper lobar pulmonary arteries were not visualized. Qualitative evaluation showed pulmonary arterial tree opacification to be excellent except for the right and left lower lateral and posterior segmental branches (52-54% rate of poor opacification). Quantitative evaluation showed four central (8%), six lobar (8%), and 206 segmental (29%) branches had poor contrast opacification (< 200 HU). Nineteen right upper lobar arteries (38%) were slightly and one was severely affected by streak artifact. At the segmental pulmonary artery level, marked differences in contrast enhancement were detected between the upper (292 ± 72 HU) and both the middle (249 ± 85 HU) and the lower lobes (248 ± 76 HU) (p < 0.01). Mean aortic opacification was 300 ± 34 HU with excellent contrast homogeneity without severe motion or streak artifacts. CONCLUSION. In the evaluation of patients presenting to the emergency department with suspected acute coronary syndrome, a dedicated coronary CT protocol enables excellent assessment of the coronary arteries and proximal ascending aorta but does not depict the pulmonary vasculature well enough for exclusion of pulmonary embolism.

AB - OBJECTIVE. The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation. MATERIALS AND METHODS. Dedicated coronary 64-MDCT data sets of 50 patients (27 men; mean age, 54 ± 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary arteries and aorta. RESULTS. Coronary image quality was excellent in 48 patients (96%) and moderate in two patients (4%). Eleven left main and 22 left upper lobar pulmonary arteries were not visualized. Qualitative evaluation showed pulmonary arterial tree opacification to be excellent except for the right and left lower lateral and posterior segmental branches (52-54% rate of poor opacification). Quantitative evaluation showed four central (8%), six lobar (8%), and 206 segmental (29%) branches had poor contrast opacification (< 200 HU). Nineteen right upper lobar arteries (38%) were slightly and one was severely affected by streak artifact. At the segmental pulmonary artery level, marked differences in contrast enhancement were detected between the upper (292 ± 72 HU) and both the middle (249 ± 85 HU) and the lower lobes (248 ± 76 HU) (p < 0.01). Mean aortic opacification was 300 ± 34 HU with excellent contrast homogeneity without severe motion or streak artifacts. CONCLUSION. In the evaluation of patients presenting to the emergency department with suspected acute coronary syndrome, a dedicated coronary CT protocol enables excellent assessment of the coronary arteries and proximal ascending aorta but does not depict the pulmonary vasculature well enough for exclusion of pulmonary embolism.

KW - Aortic disease

KW - Chest pain

KW - Coronary angiography

KW - CT

KW - Pulmonary embolism

KW - Radiography

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