1. Ashraf Badawi Consultant Cardiology Ain Shams
University
2. Multislice CT MSCT allows the 3D visualization of body organs
and is routinely used to diagnose structural pathologies in the
head, chest, & abdomen. Data from a single MSCT scan can
simultaneously provide information on the condition of the
coronaries, aorta & pulmonary arteries, rapidly investigating
important causes of chest pain 3. The Ideal Test Provide excellent
negative predictive value Accurate sensitivity to detect coronary
arterial luminal narrowing Noninvasive and very low risk 4. Ability
to rule out CAD (NPV = 99%). When the study is reported to be
normal, it is normal. This makes it more accurate than: Stress ECG.
D.S.E. StressThallium. Stress perfusion MRI. 5. Proximal non
calcified and mid segment calcified LAD plaques 6. Long mixed LCX
plaque 7. 46 yrs. Male with history of MVR, presented with acute
chest pain 8. Summary of 64 Slice Studies Year Author N Sens. Spec.
NPV Not evalu able Gantry Speed (ms) 64-Slice 2005 Leber et al 59
80% 97% 99% 0% 330 2005 Leschka et al 57 94% 97% 99% 0% 375 2005
Mollett et al 52 99% 95% 99% 2% 330 2005 Raff et al 70 86% 95% 98%
12% 330 2006 Pugliese et al 35 99% 96% 99% 0% 330 2006 Ropers et al
84 93% 97% 100% 4% 330 9. Use of multidetector computed tomography
for the assessment of acute chest pain: a consensus statement of
the North American Society of Cardiac Imaging and the European
Society of Cardiac Radiology In patients with chest pain whose
history, clinical findings and/or predisposing conditions suggest
other life-threatening diseases, specifically AAS or pulmonary
embolism, MDCT is proven to be the diagnostic study of choice. 10.
The diagnostic accuracy of 64 slice computed tomography coronary
angiography compared with stress nuclear imaging in emergency
department low-risk chest pain patients MDCT protocol demonstrated
a decrease in overall cost and diagnostic time compared with
traditional protocol. No case was complicated by a subsequent MACE
among patients discharged immediately in the MDCT protocol group
over a 6 month follow-up Gallagher MJ, Ross MA, Raff GL et al
(2007). Ann Emerg Med 49:125136. 11. Multislice CT Angiography
Offers Effective Evaluation of Chest Pain in ED 197 patients
randomized presenting to the ED with chest pain to either: MSCT.
Standard of care: Diagnostic algorithms based on serial ECG,
cardiac enzyme tests & nuclear stress testing. J Am Coll
Cardiol. 2007;49:863-871. 12. ROMICAT II Study CT vs standard care
Acute Chest Pain - Length of stay reduced by 7.6h - 47% vs 12%
discharged directly from ER Hoffman, NEJM 2012 13. Diagnostic Value
CT in Chest Pain Hoffman et al, Circulation 2009 14. Rapid and / or
irregular HR High calcium scores. Small stents 40Kg/m2)
Uncooperative or unconscious patients. 15. Symptomatic patients
with low or intermediate probability of disease. Equivocal or
non-diagnostic stress test. Triple rule out. Suspected coronary
anomalies. Assessment of graft patency post CABG. 16. CTA plays
vital role in modern cardiology. CTA is not only for ruling out
significant CAD. Knowing the appropriate indications of CTA and
having a good level of expertise optimize patient benefit from the
test.
