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MDCT Angiography of Acute Chest Pain: Evaluation of ECG-Gated and Nongated Techniques

Vassilios D. Raptopoulos1, Phillip B. Boiselle1, Nikolaos Michailidis2, Jason Handwerker1, Adeel Sabir1, Jonathan A. Edlow1, Ivan Pedrosa1 and Jonathan B. Kruskal1

1 Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
2 Department of Radiology, A.H.E.P.A. University Hospital, St. Kyriakidis, Thessaloniki 54636, Greece.


Figure 1
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  		Fig. 1 —Volume rendering of gated chest pain CT angiography image in 62-year-old man with acute onset of atypical chest pain. Scan was obtained on 16-MDCT scanner. Right coronary artery, aorta, and pulmonary arteries are seen. In this and other views (not shown), there is evidence of mild narrowing of mid right coronary artery (black arrow) and type B aortic dissection (white arrow) starting just after origin of left subclavian artery.

 

Figure 2
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  		Fig. 2A —Gated chest pain CT angiography protocol in 54-year-old woman with acute onset chest pain radiating to back. Cardiac data reconstructed at 70% of R-R interval show mild bandlike stairstep artifact throughout right coronary artery (arrow).

 

Figure 3
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  		Fig. 2B —Gated chest pain CT angiography protocol in 54-year-old woman with acute onset chest pain radiating to back. Same data as that used for A, reconstructed at 50% of R-R interval, show reduction of artifact and smoother continuity of artery.

 

Figure 4
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  		Fig. 3A —53-year-old woman with suspected aortic dissection who was scanned with gated MDCT protocol in 8-MDCT scanner. There is good visualization of left circumflex artery (LCx) including proximal and mid regions (A) and distal region (B) and obtuse marginal branches. Axis of B is orthogonal to LCx on A.

 

Figure 5
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  		Fig. 3B —53-year-old woman with suspected aortic dissection who was scanned with gated MDCT protocol in 8-MDCT scanner. There is good visualization of left circumflex artery (LCx) including proximal and mid regions (A) and distal region (B) and obtuse marginal branches. Axis of B is orthogonal to LCx on A.

 

Figure 6
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  		Fig. 4 —Mean attenuation measurements on MDCT angiography (MDCTA) at various points of pulmonary artery, heart, and aorta. From top to bottom, protocol groups are chest pain, dissection, gated, and pulmonary embolism (PE). Although locations are physiologically aligned on x-axis, scanning could not follow temporal sequence of blood circulation. Thus, distal thoracic aorta, which is physiologically last point in temporal sequence of contrast passage, was scanned first in caudal–cranial scanning mode. Considering this mode of scanning, mean values of distal thoracic aorta show that patients were scanned earliest in PE group (allowing for scanning early in the pulmonary circulation) and latest in chest pain group, as indicated by higher (later occurrence) attenuation value chosen to trigger scan. Dissection group, being in-between, allowed for a more physiologic following of IV contrast circulation at in-between time interval to produce satisfactory attenuation in both pulmonary arteries and aorta. Intravascular contrast level was sustained in gated protocol by lower injection rate. RV = right ventricle, PA = main pulmonary artery, PA/L = distal pulmonary artery to right lower lobe, PA/U = distal pulmonary artery to right upper lobe, LV = left ventricle, Ao/As = ascending aorta, Ao/Ar = aortic arch, Ao/De = mid descending thoracic aorta, Ao/Di = distal thoracic aorta.

 

Figure 7
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  		Fig. 5 —63-year-old man with acute onset of atypical chest pain, scanned with gated MDCT protocol in 8-MDCT scanner. Right coronary artery is well visualized, including acute marginal branches, and extends to posterior descending artery.

 

Figure 8
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  		Fig. 6A —66-year-old woman with atypical chest pain who underwent gated chest pain protocol on 8-MDCT scanner. Pulse rate was 72 beats per minute. Axial images show minimal motion artifact in pulmonary vessels in mid and lower chest. Ascending aorta in B is free of counterpulsation artifact.

 

Figure 9
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  		Fig. 6B —66-year-old woman with atypical chest pain who underwent gated chest pain protocol on 8-MDCT scanner. Pulse rate was 72 beats per minute. Axial images show minimal motion artifact in pulmonary vessels in mid and lower chest. Ascending aorta in B is free of counterpulsation artifact.

 

Figure 10
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  		Fig. 6C —66-year-old woman with atypical chest pain who underwent gated chest pain protocol on 8-MDCT scanner. Pulse rate was 72 beats per minute. Coronal plane shows fragmentation of pulmonary vessels and bands along diaphragm (arrow).

 

Figure 11
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  		Fig. 6D —66-year-old woman with atypical chest pain who underwent gated chest pain protocol on 8-MDCT scanner. Pulse rate was 72 beats per minute. Bands are seen on coronal plane along ascending aorta (arrow).

 

Figure 12
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  		Fig. 7A —60-year-old man with history of coronary artery bypass who was scanned on 16-MDCT scanner with gated MDCT chest pain protocol. Pulse rate was 80 beats per minute. Axial image reconstructed at 75% of R-R interval shows little, if any, motion artifact.

 

Figure 13
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  		Fig. 7B —60-year-old man with history of coronary artery bypass who was scanned on 16-MDCT scanner with gated MDCT chest pain protocol. Pulse rate was 80 beats per minute. Axial image reconstructed at 45% of R-R interval shows severe pulsation artifact.

 

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