Role of Multislice CT Angiography in Assessment of Vascular Causes of Chest Pain

Abstract

Chest pain is one of the most common and important presenting symptoms in the daily clinical visits and emergency medicine. It is important to know the different causes of acute chest pain which include: Thoracic (heart, lung, aorta, oesophagus and chest wall), abdominal and psychiatric origins. Differentiating the life threatening causes of acute chest pain, such as acute coronary syndrome, acute aortic syndrome, pulmonary embolism, tension pneumothorax, rupture oesophagus and pericardial tamponade, from other potentially non threatening causes of acute chest pain is also crucial. In addition to improved technology, the increasing placement of CT scanners in or near the ED suite is another factor that has heightened the attractiveness of using multidetector CT to evaluate acute chest pain. The published studies revealed high negative predictive value and high specificity of CT coronary angiography. The high NPV means low false negative results and the high specificity means high true positive results. In view of the high NPV, it seems probable that patients without significant coronary artery disease would be selected accurately at CT, and hence, avoiding the unnecessary invasive coronary angiography. Coronary artery bypass grafts (CABG) are important issues being suitable for imaging with MSCT angiography. Patency or occlusion of grafts can be established by the presence or absence of contrast material within, respectively. Because of their relatively large size and less motion with heart beats; the grafts are generally better evaluated for the presence and severity of stenosis.