The triple rule out CT in acute chest pain: a challenge for emergency radiologists?
Open Access
- 1 August 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Emergency Radiology
- Vol. 28 (4), 735-742
- https://doi.org/10.1007/s10140-021-01911-8
Abstract
Purpose To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. Methods Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist-CR, an emergency senior radiologist-SER, and an emergency junior radiologist-JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. Results Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. Conclusions Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The "undedicated" radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.Funding Information
- Alma Mater Studiorum - Università di Bologna
This publication has 19 references indexed in Scilit:
- Triple Rule-out Computed Tomographic Angiography for Chest Pain: A Diagnostic Systematic Review and Meta-AnalysisAcademic Emergency Medicine, 2013
- Cardiac CT in the Emergency DepartmentCardiology Clinics, 2012
- „Triple-rule-out“-Computertomographie in der NotaufnahmeMedizinische Klinik - Intensivmedizin und Notfallmedizin, 2011
- Recommandations pour la formation en imagerie en coupes du cœur et des vaisseauxJournal de Radiologie, 2009
- Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease)European Radiology, 2008
- Evaluation of a “Triple Rule-Out” Coronary CT Angiography Protocol: Use of 64-Section CT in Low-to-Moderate Risk Emergency Department Patients Suspected of Having Acute Coronary SyndromeRadiology, 2008
- Diagnostic Performance of Multidetector CT Angiography for Assessment of Coronary Artery Disease: Meta-analysisRadiology, 2007
- Diagnostic Accuracy of Image Postprocessing Methods for the Detection of Coronary Artery Stenoses by Using Multidetector CT1Radiology, 2007
- Prognostic Value of Multislice Computed Tomography Coronary Angiography in Patients With Known or Suspected Coronary Artery DiseaseJournal of the American College of Cardiology, 2007
- Chest Pain Centers: Diagnosis of Acute Coronary SyndromesAnnals of Emergency Medicine, 2000