Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography

• Published in: Radiology Vol. 243; no. 2; p. 368
• Main Authors: Vrachliotis, Thomas G, Bis, Kostaki G, Haidary, Ahmad, Kosuri, Rajani, Balasubramaniam, Mamtha, Gallagher, Michael, Raff, Gilbert, Ross, Michael, O'neil, Brian, O'neill, William
• Format: Journal Article
• Language: English
• Published: United States 01.05.2007
• Subjects: Adult; Aged; Angiography - methods; Aortography - methods; Chest Pain - diagnostic imaging; Coronary Angiography - methods; Female; Humans; Image Enhancement - methods; Male; Middle Aged; Pulmonary Artery - diagnostic imaging; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - instrumentation; Tomography, X-Ray Computed - methods
• ISSN: 0033-8419
• DOI: 10.1148/radiol.2432060447

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. 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. 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. 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.