Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department

Yoo, Seung Min; Chun, Eun Ju; Lee, Hwa Yeon; Min, Daniel; White, Charles S.

doi:10.1097/rti.0000000000000241

Cited by 19 publications

(18 citation statements)

References 33 publications

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“…The advantages of CAD-RADS are a standardised method of reporting coronary CTA: providing a single, per-patient severity score and providing recommendations for further investigation of the patients [ 8 - 10 ]. Thus, this reporting system provides a common language between radiologists and clinicians to increase the clarity in reporting and recommendation for the management of coronary artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Inter-observer agreement of the Coronary Artery Disease Reporting and Data System (CAD-RADS<sup>TM</sup>) in patients with stable chest pain

Razek¹,

Elrakhawy²,

Youssef³

et al. 2018

Pol J Radiol

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PurposeTo assess inter-observer variability of the Coronary Artery Disease – Reporting and Data System (CAD-RADS) for classifying the degree of coronary artery stenosis in patients with stable chest pain.Material and methodsA prospective study was conducted upon 96 patients with coronary artery disease, who underwent coronary computed tomography angiography (CTA). The images were classified using the CAD-RAD system according to the degree of stenosis, the presence of a modifier: graft (G), stent (S), vulnerable plaque (V), or non-diagnostic (n) and the associated coronary anomalies, and non-coronary cardiac and extra-cardiac findings. Image analysis was performed by two reviewers. Inter-observer agreement was assessed.ResultsThere was excellent inter-observer agreement for CAD-RADS (k = 0.862), at 88.5%. There was excellent agreement for CAD-RADS 0 (k = 1.0), CAD-RADS 1 (k = 0.92), CAD-RADS 3 (k = 0.808), CAD-RADS 4 (k = 0.826), and CAD-RADS 5 (k = 0.833) and good agreement for CAD-RADS 2 (k = 0.76). There was excellent agreement for modifier G (k = 1.0) and modifier S (k = 1.0), good agreement for modifier N (k = 0.79), and moderate agreement for modifier V (k = 0.59). There was excellent agreement for associated coronary artery anomalies (k = 0.845), non-coronary cardiac findings (k = 0.857), and extra-cardiac findings (k = 0.81).ConclusionsThere is inter-observer agreement of CAD-RADS in categorising the degree of coronary arteries stenosis, and the modifier of the system and associated cardiac and extra-cardiac findings.

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Section: Discussionmentioning

confidence: 99%

“…This procedure is a relatively fast and simple procedure that does not require arterial access or hospital admission. The images can be post-processed and reconstructed during different cardiac phases to allow retrospective selection of the phases with the fewest motion artefacts [ 8 - 12 ].…”

Section: Introductionmentioning

confidence: 99%

Inter-observer agreement of the Coronary Artery Disease Reporting and Data System (CAD-RADS<sup>TM</sup>) in patients with stable chest pain

Razek¹,

Elrakhawy²,

Youssef³

et al. 2018

Pol J Radiol

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“…However, CMR shows normal results in 8-67% of patients with MINOCA/ TpNOCA and has limited availability due to requiring a long examination time and being high cost. As an alternative imaging tool, cardiac computed tomography (CT) has the potential ability for evaluating MINOCA/TpNOCA since it can comprehensively analyze the coronary artery anatomy, myocardial perfusion, wall motion of both the ventricles, and extracardiac structures such as pulmonary arteries Troponin-positive non-obstructive coronary arteries kjronline.org and the aorta (10). Table 1 summarizes the advantages and limitations of various imaging tools for evaluation of MINOCA/TpNOCA.…”

Section: Role Of Multimodality Imaging Tools For Evaluation Of Tpnocamentioning

confidence: 99%

Troponin-Positive Non-Obstructive Coronary Arteries and Myocardial Infarction with Non-Obstructive Coronary Arteries: Definition, Etiologies, and Role of CT and MR Imaging

et al. 2020

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In approximately 10% of patients with acute myocardial infarction (MI), angiography does not reveal an obstructive coronary stenosis. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA), which has complex and multifactorial causes. However, this term can be confusing and open to dual interpretation, because MINOCA is also used to describe patients with acute myocardial injury caused by ischemia-related myocardial necrosis. Therefore, with regards to this specific context of MINOCA, the generic term for MINOCA should be replaced with troponin-positive with non-obstructive coronary arteries (TpNOCA). The causes of TpNOCA can be subcategorized into epicardial coronary (causes of MINOCA), myocardial, and extracardiac disorders. Cardiac magnetic resonance imaging can confirm MI and differentiate various myocardial causes, while cardiac computed tomography is useful to diagnose the extracardiac causes.

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“…See the ACR Appropriateness Criteria Ò topics on "Acute Chest Pain-Suspected Aortic Dissection" [17], "Suspected Pulmonary Embolism" [18], and "Acute Nonlocalized Abdominal Pain" [19] for further information. As nonspecific chest pain could also include nonischemic etiologies that arise from adjacent sources such as within the bony thorax, gastrointestinal (GI) system, or upper abdomen [20], a careful history and physical examination are paramount to target any subsequent imaging to the coronaries and heart structures.…”

Section: Summary Of Literature Review Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease

Beache

Mohammed

Koweek

et al. 2020

Journal of the American College of Radiology

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Patients with acute nonspecific chest pain and low probability for coronary disease remain an important clinical management dilemma. We focus on evidence for imaging, in an integrated decision-making setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department

Cited by 19 publications

References 33 publications

Inter-observer agreement of the Coronary Artery Disease Reporting and Data System (CAD-RADS<sup>TM</sup>) in patients with stable chest pain

Inter-observer agreement of the Coronary Artery Disease Reporting and Data System (CAD-RADS<sup>TM</sup>) in patients with stable chest pain

Troponin-Positive Non-Obstructive Coronary Arteries and Myocardial Infarction with Non-Obstructive Coronary Arteries: Definition, Etiologies, and Role of CT and MR Imaging

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease

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