1. Ashraf Badawi
Consultant Cardiology
Ain Shams University

2. Multislice CT
• MSCT allows the 3D visualization of body
organs and is routinely used to diagnose
structural pathologies in the head, chest, &
abdomen.
• Data from a single MSCT scan can
simultaneously provide information on the
condition of the coronaries, aorta & pulmonary
arteries, rapidly investigating important causes
of chest pain

4. The Ideal Test
• Provide excellent negative predictive
value
• Accurate sensitivity to detect coronary
arterial luminal narrowing
• Noninvasive and very low risk

5.  Ability to rule out CAD (NPV = 99%).
 When the study is reported to be normal, it is
normal.
 This makes it more accurate than:
 Stress ECG.
 D.S.E.
 StressThallium.
 Stress perfusion MRI.

10. Proximal non calcified and mid
segment calcified LAD plaques

11. Long mixed LCX plaque

12. 46 yrs. Male with history of MVR,
presented with acute chest pain

15. Summary of 64 Slice Studies
Year Author N Sens. Spec. NPV Not
evalu
able
Gantry
Speed
(ms)
64-Slice
2005 Leber et al 59 80% 97% 99% 0% 330
2005 Leschka et al 57 94% 97% 99% 0% 375
2005 Mollett et al 52 99% 95% 99% 2% 330
2005 Raff et al 70 86% 95% 98% 12% 330
2006 Pugliese et al 35 99% 96% 99% 0% 330
2006 Ropers et al 84 93% 97% 100% 4% 330

16. Use of multidetector computed tomography for the assessment of acute chest
pain: a consensus statement of the North American Society of Cardiac
Imaging and the European Society of Cardiac Radiology
 In patients with chest pain whose history,
clinical findings and/or predisposing
conditions suggest other life-threatening
diseases, specifically AAS or pulmonary
embolism, MDCT is proven to be the
diagnostic study of choice.

17. The diagnostic accuracy of 64 slice computed tomography
coronary angiography compared with stress nuclear imaging
in emergency department low-risk chest pain patients
 MDCT protocol demonstrated a decrease in overall
cost and diagnostic time compared with
traditional protocol.
 No case was complicated by a subsequent MACE
among patients discharged immediately in the
MDCT protocol group over a 6 month follow-up
Gallagher MJ, Ross MA, Raff GL et al (2007). Ann Emerg Med 49:125–136.

18. Multislice CT Angiography Offers Effective
Evaluation of Chest Pain in ED
 197 patients randomized presenting to the ED with
chest pain to either:
 MSCT.
 Standard of care:
 Diagnostic algorithms based on serial ECG, cardiac enzyme
tests & nuclear stress testing.
J Am Coll Cardiol. 2007;49:863-871.

19. ROMICAT II Study
CT vs standard care Acute Chest Pain
- Length of stay reduced by 7.6h
- 47% vs 12% discharged directly from ER Hoffman, NEJM 2012

22. Diagnostic Value CT in Chest Pain
Hoffman et al, Circulation 2009

23.  Rapid and / or irregular HR
 High calcium scores.
 Small stents <3 mm
 Contrast requirements (CRI)
 Obese (BMI > 40Kg/m2)
 Uncooperative or unconscious patients.

24.  Symptomatic patients with low or intermediate
probability of disease.
 Equivocal or non-diagnostic stress test.
 Triple rule out.
 Suspected coronary anomalies.
 Assessment of graft patency post CABG.

25.  CTA plays vital role in modern cardiology.
 CTA is not only for ruling out significant
CAD.
 Knowing the appropriate indications of CTA
and having a good level of expertise
optimize patient benefit from the test.