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Emergency Cardiac CT for Suspected Acute Coronary Syndrome: Qualitative and Quantitative Assessment of Coronary, Pulmonary, and Aortic Image Quality

Jonathan D. Dodd1,2,3, Sanjeeva Kalva2, Antonio Pena1, Fabien Bamberg1, Michael D. Shapiro1, Suhny Abbara1,2, Ricardo C. Cury1,2, Thomas J. Brady1,2 and Udo Hoffmann1,2

1 Cardiac MRI–PET–CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
2 Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
3 Present address: Cardiac CT–MRI Program, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.


Figure 1
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  		Fig. 1A —58-year-old man who presented to emergency department with acute chest pain. Righted-sided pulmonary arterial circulation (A) and left-sided pulmonary arterial circulation (B) coronary CT scans show mean contrast enhancement (HU) of pulmonary arterial segments. Mean vessel opacification decreases in craniocaudal direction as contrast agent passes from pulmonary to systemic circulation during dedicated cardiac MDCT acquisition. apic = apical; seg = segment; ant = anterior; post = posterior; rul = right upper lobe; rpa = right pulmonary artery; rll = right lower lobe; rml = right middle lobe; sup = superior; med = medial; lat = lateral; lul = left upper lobe; lpa = left pulmonary artery; lll = left lower lobe; ling = lingula; inf = inferior.

 

Figure 2
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  		Fig. 1B —58-year-old man who presented to emergency department with acute chest pain. Righted-sided pulmonary arterial circulation (A) and left-sided pulmonary arterial circulation (B) coronary CT scans show mean contrast enhancement (HU) of pulmonary arterial segments. Mean vessel opacification decreases in craniocaudal direction as contrast agent passes from pulmonary to systemic circulation during dedicated cardiac MDCT acquisition. apic = apical; seg = segment; ant = anterior; post = posterior; rul = right upper lobe; rpa = right pulmonary artery; rll = right lower lobe; rml = right middle lobe; sup = superior; med = medial; lat = lateral; lul = left upper lobe; lpa = left pulmonary artery; lll = left lower lobe; ling = lingula; inf = inferior.

 

Figure 3
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  		Fig. 2 —Graph shows mean changes in attenuation from central pulmonary artery to main branch, lobar, and segmental pulmonary artery levels for each lobe. Mean attenuation decreased from 292 ± 72 HU for upper lobe segmental vessels to 248 ± 76 HU for lower lobe segmental vessels (p < 0.001).

 

Figure 4
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  		Fig. 3 —51-year-old man who presented to emergency department with acute chest pain. CT scan shows mean qualitative attenuation results for aorta at level of aortic sinus and most cranial and caudal aspects of scan range. Regions of interest were placed at five levels in thoracic aorta (level of sinuses of descending aorta not shown) and on entire scan range of descending aorta, which provide overall assessment of contrast opacification throughout scan.

 

Figure 5
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  		Fig. 4A —Scatterplots show results of Bland-Altman analysis for interobserver agreement in qualitative scoring of pulmonary arteries. No systematic bias was recorded for main pulmonary artery, but observer 2 systematically scored lobar and segmental pulmonary arteries lower than did observer 1. Main pulmonary artery.

 

Figure 6
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  		Fig. 4B —Scatterplots show results of Bland-Altman analysis for interobserver agreement in qualitative scoring of pulmonary arteries. No systematic bias was recorded for main pulmonary artery, but observer 2 systematically scored lobar and segmental pulmonary arteries lower than did observer 1. Lobar pulmonary artery.

 

Figure 7
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  		Fig. 4C —Scatterplots show results of Bland-Altman analysis for interobserver agreement in qualitative scoring of pulmonary arteries. No systematic bias was recorded for main pulmonary artery, but observer 2 systematically scored lobar and segmental pulmonary arteries lower than did observer 1. Segmental pulmonary artery.

 

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