![]() ![]() Mean aortic opacification was 300 +/- 34 HU with excellent contrast homogeneity without severe motion or streak artifacts. At the segmental pulmonary artery level, marked differences in contrast enhancement were detected between the upper (292 +/- 72 HU) and both the middle (249 +/- 85 HU) and the lower lobes (248 +/- 76 HU) (p < 0.01). Nineteen right upper lobar arteries (38%) were slightly and one was severely affected by streak artifact. Quantitative evaluation showed four central (8%), six lobar (8%), and 206 segmental (29%) branches had poor contrast opacification (< 200 HU). Qualitative evaluation showed pulmonary arterial tree opacification to be excellent except for the right and left lower lateral and posterior segmental branches (52-54% rate of poor opacification). Eleven left main and 22 left upper lobar pulmonary arteries were not visualized. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary arteries and aorta.Ĭoronary image quality was excellent in 48 patients (96%) and moderate in two patients (4%). The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation.ĭedicated coronary 64-MDCT data sets of 50 patients (27 men mean age, 54 +/- 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. ), The use of calcium scoring and pretest risk appeared to reduce the number of unnecessary cardiac investigations in our patients: however, the calcium scoring test produced a high number of incidental findings on the associated CT scans. The correlations between all major risk factors and calcium scores were weak except for a combination of diabetes and hypertension in the male gender ( 164 patients with incidental findings on the chest CT (computed tomography) accompanying calcium scoring were reviewed, of which 88 patients underwent further tests and follow-up for noncardiac causes of chest pain. After further tests, 267 patients were discharged with no further cardiac therapy, 88 patients were discharged with additional medical therapy, and 19 patients underwent coronary artery by-pass grafting or percutaneous intervention. Of the 206 patients with zero calcium score, 132 patients were immediately discharged from cardiac follow-up with no further investigation on the basis of their calcium score, low pretest risk of coronary artery disease, and no significant incidental findings. The patients were followed up for two years and further investigations and outcomes recorded. 462 patients presenting with chest pain to a rural district general hospital underwent calcium scoring and pretest clinical risk assessment in order to stratify subsequent investigations and treatment was retrospectively reviewed.
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