Dual-phase computed tomography imaging in acute chest pain: emerging protocols and potential future implications

摘要

Acute chest pain constitutes one of the most common presentations to the Emergency Department. The aetiology of chest pain can range from benign musculoskeletal chest pain to potentially life-threatening emergencies such as an acute coronary syndrome (ACS), aortic dissection (AAS), or pulmonary embolism (PE). The discrimination of patients with acute pathology can be particularly challenging, as these patients typically present with a variety of clinical manifestations. The accurate and rapid diagnosis of patients with an immediate risk of complications is therefore crucial for institution of appropriate acute management. Advances in cardiac computed tomography (CT) imaging have allowed for rapid and accurate non-invasive assessment of a number of cardiac, pulmonary, and vascular pathologies. Despite its high negative predictive power, the utility of cardiac CT is limited by the need for an optimal heart rate, iodinated contrast, and involves radiation exposure. Therefore, protocols which minimise radiation dose exposure while maintaining high diagnostic accuracy are important to ensure safe and effective application of this tool. Increased demand for rapid result imaging in acute chest pain has established the utility of two dual-phase cardiac CT imaging protocols.