THE IMPACT OF MULTI SLICE COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF ACUTE CHEST PAIN

Abstract

OBJECTIVE: To address the clinical value of recent advances of Multislice Computed Tomography in the diagnosis of the major life –threatening causes of acute chest pain. SUBJECTS AND METHODS: Twenty five patients with atypical acute chest pain and low to intermediate cardiovascular risk underwent dedicated coronary CT angiography (CCTA). Other 15 patients with high clinical suspicion of pulmonary embolism or aortic dissection were referred for conventional CT angiography. The CT was carried on using GE light speed VCT 64. RESULTS: Of the 25 patients suspected to have coronary artery disease, 2 patients showed non diagnostic quality scans due to extensive coronary artery calcification and 13 patients showed positive CCTA findings with only 3 showing significant > 50% stenosis. On the other hand ,6 patients out of the 15 suspected to have pulmonary embolism or aortic dissection showed positive findings. CONCLUSION: CCTA provides the potential to rapidly and reliably diagnose or exclude acute coronary syndrome in patients with acute chest pain but low to intermediate cardiovascular risk. CT is also a well established tool for the diagnosis of acute aortic dissection and pulmonary embolism. Recent technical developments now permit acquisition of well-opacified images of the coronary arteries, thoracic aorta and pulmonary arteries from a single CT scan. While this so called triple-rule out scan protocol can potentially exclude fatal causes of chest pain in all three vascular beds, the attendant higher radiation dose of this method precludes its routine use except in selected cases.

Key Words: MSCT acute chest pain; CCTA; MSCT coronary disease; MSCT aortic dissection; MSCT pulmonary embolism.