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Atypical Chest Pain: Coronary, Aortic, and Pulmonary Vasculature Enhancement at Biphasic Single-Injection 64-Section CT Angiography¹

¹ From the Departments of Radiology (K.G.B., A.H.), Cardiology (R.K., M.G., G.R., W.O.), and Emergency Medicine (M.R., B.O.), and Biostatistics–William Beaumont Research Institute (M.B.), William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073; and the Department of Radiology, Henry Dunant Hospital, Athens, Greece (T.G.V.). Received March 11, 2006; revision requested May 10; final revision received June 8; accepted June 22; final version accepted, September 5. Address correspondence to K.G.B. (e-mail: kbis{at}beaumont.edu).

Purpose: 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.

Materials and Methods: 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.

Results: 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.

Conclusion: 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.

© RSNA, 2007