ACR-SPR-STR Practice Parameter for the Performance of Cardiac Positron Emission Tomography - Computed Tomography (PET/CT) Imaging.

This clinical practice parameter has been developed collaboratively by the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Thoracic Radiology (STR). This document is intended to act as a guide for physicians performing and interpreting positron emission tomography-computed tomography (PET/CT) of cardiac diseases in adults and children. The primary value of cardiac PET/CT imaging include evaluation of perfusion, function, viability, inflammation, anatomy, and risk stratification for cardiac-related events such as myocardial infarction and death. Optimum utility of cardiac PET/CT is achieved when images are interpreted in conjunction with clinical information and laboratory data. Measurement of myocardial blood flow, coronary flow reserve and detection of balanced ischemia are significant advantages of cardiac PET perfusion studies. Increasingly cardiac PET/CT is used in diagnosis and treatment response assessment for cardiac sarcoidosis.

Cardiac CT in the emergency department: convincing evidence, but cautious implementation.

In clinical practice, assessment of chest pain patients presenting to the emergency department is difficult and the work-up can be lengthy and costly. There is growing evidence supporting the use of coronary computed tomography angiography (CTA) in early assessment of patients presenting with acute chest pain to the emergency department. CTA appears to be a faster and more accurate way to diagnosis or rule out coronary stenosis, leading to reduced hospital admissions, decreased time in the ED and lower costs. The focus of this article is to review the current literature of the use of Coronary CTA and "triple rule out" protocols in the emergency department setting and to provide a chest pain algorithm, showing how Coronary CTA can be implemented effectively in clinical practice. Potential pitfalls and requirements for implementation will also be discussed.

Acute chest pain imaging in the emergency department with cardiac computed tomography angiography.

In practice, the determination of ischemic chest pain in the emergency department (ED) population is difficult and errors are common. Cardiac computed tomography angiography has recently emerged for accurate noninvasive evaluation of coronary artery disease, and it may offer a promising new approach to improve the triage of patients presenting to the ED with acute chest pain, in particular in terms of a faster and accurate way to determine the diagnosis, which could effectively reduce hospital admissions and costs. The focus of this article is to review the current literature on the use of cardiac computed tomography angiography in the ED setting by providing pooled sensitivity, specificity, and positive and negative predictive values of the published literature to date. Moreover, different protocols for detection of patients with cardiac and other, noncardiac causes of chest pain (triple rule-out protocol) are discussed.

Measurement of Coronary Artery Calcium in Elderly Patients.

Quantification of coronary artery calcium by electron beam and spiral computed tomography (CT) is being increasingly utilized as a technique to assess the presence and extent of coronary artery disease (CAD) as well as the prognosis for clinical events in both symptomatic and asymptomatic individuals. Much of the demand for this procedure is generated by patients exposed to marketing efforts, and patients often ask physicians about the value of this test. Since elderly patients have a high prevalence of coronary artery calcium as well as a higher incidence of clinical CAD, the interpretation and clinical utility of this test differs from that for younger individuals. This paper attempts to review currently available information concerning coronary artery calcium quantification and its potential uses in elderly patients. (c)1999 by Quantification of coronary artery calcium by electron beam and spiral computed tomography (CT) is being increasingly utilized as a technique to assess the presence and extent of coronary artery disease (CAD) as well as the prognosis for clinical events in both symptomatic and asymptomatic individuals. Much of the demand for this procedure is generated by patients exposed to marketing efforts, and patients often ask physicians about the value of this test. Since elderly patients have a high prevalence of coronary artery calcium as well as a higher incidence of clinical CAD, the interpretation and clinical utility of this test differs from that for younger individuals. This paper attempts to review currently available information concerning coronary artery calcium quantification and its potential uses in elderly patients. (c)1999 by CVRR, Inc.