Abstract
Evaluation of patients presenting with chest pain to the emergency department remains a challenging task because of a variety of etiologies that range from benign to potentially fatal. Although majority of patients do not have myocardial ischemia as the cause of their presentation, the clinical work up can be time consuming, costly and inconclusive. Recent technical advances in cardiac computed tomography and magnetic resonance imaging have led to better diagnostic accuracy in evaluating patients with chest pain. In this paper, we review the role of cardiac computed tomography and magnetic resonance imaging in evaluating patients with chest pain in the emergency department.
Similar content being viewed by others
References
Lee TH, Rouan GW, Weisberg MC et al (1987) Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol 60:219–224
McCarthy BD, Beshansky JR, D’ Agostino RB, Selker HP (1993) Missed diagnosis of acute myocardial infarction in the emerygency department: results from a multicenter study. Ann Emerg Med 22:579–582
Hoffmann U, Pena A, Cury R et al (2006) Cardiac CT in emergency department patients with acute chest pain. Radiographics 26:963–980
Antman EM, Cohen M, Bernick PJ et al (2000) The TIMI risk score for unstable angina/non-ST elevation MI. JAMA 284:835–842
Braunwald E, Antman EM, Beasley JW et al (2002) ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 7:1366–1374
Rifkin RD, Parisi AF, Folland E (1979) Coronary calcification in the diagnosis of coronary artery disease. Am J Cardiol 44:141–147
McCarthy JH, Palmer FJ (1974) Incidence and significance of coronary artery calcification. Br Heart J 36:499–506
Becker CR, Kleffel T, Crispin A et al (2001) Coronary artery calcium measurement: agreement of multirow detector and electron beam CT. AJR Am J Roentgenol 176:1295–1298
Rumberger JA, Simons DB, Fitzpatrick LA et al (1995) Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation 92:2157–2162
Baumgart D, Schmermund A, Goerge G et al (1997) Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. JACC 30:57–64
Budoff MJ, Georgiou D, Brody A et al (1996) Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circulation 93:898–904
Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832
Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252
Nasir K, Michos ED, Blumenthal RS et al (2005) Detection of high-risk young adults and women by coronary calcium and National Cholesterol Education Program Panel III guidelines. J Am Coll Cardiol 46:1931–1936
Haberl R, Becker A, Leber A et al (2001) Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol 37:451–457
Hecht HS, Budoff MJ, Berman DS, Ehrlich J, Rumberger JA (2006) Coronary artery calcium scanning: clinical paradigms for cardiac risk assessment and treatment. Am Heart J 151:1139–1146
McLaughlin VV, Balogh T, Rich S et al (1999) Utility of electron beam computed tomography to stratify patients presenting to the emergency room with chest pain. Am J Cardiol 84:327–328, A8
Laudon DA, Vukov LF, Breen JF et al (1999) Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. Ann Emerg Med 33:15–21
Georgiou D, Budoff MJ, Kaufer E et al (2001) Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. J Am Coll Cardiol 38:105–110
Hideya Y, Matthew JB, Bin L et al (2002) Reproducibility of three different scoring systems for measurement of coronary calcium. Int J Cardiovasc Imaging 5:391–397
Rubinshtein R, Gasper T, Halon DA et al (2007) Prevalence and extent of obstructive coronary artery disease among patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography by evaluation of a chest pain syndrome. Am J Cardiol 99:472–475
Burke AP, Taylor A, Farb A et al (2000) coronary calcification: insights from sudden coronary death victims. Z Kardiol 89(suppl 2):49–53
Greenland P, La Bree L, Azen SP et al (2004) Coronary calcium score combined with framingham score for risk reduction in asymptomatic individuals. JAMA 291:210–215
Scanlon PJ, Faxon DP, Audet AM et al (1999) ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). J Am Coll Cardiol 33:1756–1824
Leschka S, Alkadhi H, Plass A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487
Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. JACC 46:147–154
Raff GL, Gallagher MJ, O’Neill WW et al (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557
Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323
Gibbons RJ, Balady GJ, Bricker JT et al (2002) ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 40:1531–1540
White CS, Kuo D, Kelemen M et al (2005) chest pain evaluation in the emergency department: Can MDCT provide a comprehensive evaluation. Am J Radiol 185:533–540
Gallagher MJ, Ross MA, Raff GL (2007) The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med 49:125–136
Hoffmann U, Nagurney J, Moselewiski F et al (2006) Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 114:2251–2260
Goldstein J, Gallagher M, O’Neill W et al (2007) A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 49:863–871
Rubenshtein R, Halon DA, Gaspar T et al (2007) Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation 115:1762–1768
Budoff MJ, Cohen MC, Garcia MJ et al (2005) ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol 46:383–402
Coles DR, Smail MA, Negus IS et al (2006) Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 47:1840–1845
Stephen Amis E, Priscilla FB, Kimberly EA et al (2007) American college of radiology white paper on radiation dose in medicine. J Am Coll Radiol 5:272–284
Einstein AJ, Henzlova MJ, Rajagopalan S et al (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323
Thompson RC, Cullom SJ (2006) Issues regarding radiation dosage of cardiac nuclear and radiography procedures. J Nucl Cardiol 13:19–23
Hausleiter J, Meyer T, Hadamitzky M et al (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 113:1305–1310
Kwong R, Schussheim A, Rekhraj S et al (2003) Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation 107:531–537
Ingkanisorn WP, Kwong RY, Bohme NS et al (2006) Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain. J Am Coll Cardiol 47:1427–1432
Martin ET, Coman JA, Shellock FG et al (2004) Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla. J Am Coll Cardiol 43:1315–1324
Roguin A, Zviman MM, Meininger GR et al (2004) Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe. In vitro and in vivo assessment of safety and function at 1.5 T. Circulation 110:475–482
Hendel RC, Patel MR, Kramer CM et al (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol 48:1475–1497
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salah, A., Moliterno, D.J., Humphries, R. et al. Role of cardiac computed tomography and magnetic resonance imaging in the evaluation of acute chest pain in the emergency department. Int J Cardiovasc Imaging 24, 331–342 (2008). https://doi.org/10.1007/s10554-007-9266-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-007-9266-0