Dual Source CT Triple Rule out without ß-Blocker
Christoph R. Becker, MD, Section Chief Computed Tomography
Department of Clinical Radiology, Ludwig-Maximilians-University Munich – Großhadern Campus
A 60 year old male patient arrives in the Radiology Department of the University Hospital in Munich, Großhadern. He has been suffering from a severe chest pain. To rule out the major causes of chest pain such as myocardial infarction, pulmonary embolism, and aortic dissection in a one-stop diagnosis the patient was transferred directly to the CT department. A gated scan of chest was performed without the use of ß-Blockers on the SOMATOM Definition.
The gated chest pain protocol of the SOMATOM Definition enables the immediate visualization of the entire thorax as well the coronary arteries without motion artifacts. As shown in the images below, a Stanford type B aortic dissection has been identified. The patient was referred to Vascular Surgery Department for stent placement.
Chest pain is one of the most common and complex symptoms for which patients seek medical care. With standard diagnostic evaluation, patients with chest pain undergo multiple serial tests and long observation periods. This ties up staff as well as space for up to a whole day. Dual Source CT enables us to quickly rule out the major causes of chest pain such as myocardial infarction, pulmonary embolism, and aortic dissection in a one-stop diagnosis without the compromise of beta-blockers. Now we can accurately triage chest-pain patients within 10 minutes after presenting to our department. With the SOMATOM Definition a special Chest Pain protocol can be used applying reduced dose to the patient through the combination of two scan ranges, a cardio scan and a thorax scan. The dose modulation along the patient axis is performed with an optimized dose for each of the corresponding regions. In combination with a simple contrast injection protocol of 80 ml with a flow rate of 4,5 ml/s Dual Source CT enabled us to establish the chest pain evaluation into our daily routine.