Acute Chest Pain- Role of MDCT in evaluation

Acute Chest pain is a medical emergency and causes a lot of anxiety to the patient and the physician as well in view of the risk of mortality and morbidity. However, Causes of chest pain can be cardiac or non-cardiac with sometimes cardiac cases having non-specific presentation. Physicians and Radiologists are always in a quest of a comprehensive method of Chest Pain Evaluation.

“Chest pain is one of the most frequent complaints for patients seen in the emergency department. There is a lot of discussion focusing on the potential utility use of cross-sectional imaging, particularly multidetector CT, in the evaluation of chest pain in the emergency department.”
Reference- White C, Read K, Kuo D in Eur J Radiol. 2006 Jan 21; Assessment of chest pain in the emergency room: What is the role of multidetector CT?


“In a previous Article by White et al, a study was done to determine whether MDCT can provide a comprehensive assessment of cardiac and noncardiac causes of chest pain in stable emergency department patients. Patients with chest pain who presented to the emergency department without definitive findings of acute myocardial infarction based on history, physical examination, and ECG were recruited immediately after the initial clinical assessment.

The images were evaluated for cardiac (coronary calcium and stenosis, ejection fraction, and wall motion and perfusion) and significant noncardiac (pulmonary embolism, dissection, pneumonia, and so forth) causes of chest pain. Sixty-nine patients met all criteria for enrollment in the study, of whom 45 (65%) would not otherwise have undergone CT. Fifty-two patients (75%) had no significant CT findings and a final diagnosis of clinically insignificant chest pain. Thirteen patients (19%) had significant CT findings (cardiac, 10; noncardiac, 3) concordant with the final diagnosis. CT failed to suggest a diagnosis in two patients (3%), both of whom proved to have clinically significant coronary artery stenoses. In two patients (3%), CT overdiagnosed a coronary stenosis. Sensitivity and specificity for the establishment of a cardiac cause of chest pain were 83% and 96%, respectively. Overall sensitivity and specificity for all other cardiac and noncardiac causes were 87% and 96%, respectively. "

ECG-gated MDCT appears to be logistically feasible and shows promise as a comprehensive method for evaluating cardiac and noncardiac chest pain in stable emergency department patients. Further hardware and software improvements will be necessary for adoption of this paradigm in clinical practice.

Reference-White CS, Kuo D, Kelemen M, Jain V, Musk A, Zaidi E, Read K, Sliker C, Prasad R. AJR Am J Roentgenol. 2005 Aug;185(2):533-40. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation?