Noncontrast angiographic whole-heart acquisition with 3-D steady-state free precession MRI technique can provide imaging of the coronary arteries and is particularly useful in the evaluation of coronary anomalies, bypass graft assessment, and coronary aneurysm formation [133]. Trials have demonstrated high sensitivity and moderate specificity of coronary MRA for the evaluation of obstructive coronary artery stenosis, particularly when used in combination with nonangiographic CMR sequences [119,134]. Future avenues of clinical use include reliable evaluation of coronary artery stenosis and characterization of plaque composition for the identification of vulnerable or high-risk plaques [135]. In patients without ST-segment elevation, positive cardiac biomarkers may nonetheless suggest myocardial necrosis, and the ECG may demonstrate a NSTE ischemic pattern, including ST depression, transient ST-segment elevation, or prominent T-wave inversions [139]. ACS patients with unstable angina may have similar ECG patterns but demonstrate no biomarker evidence of myocardial necrosis (eg, troponin level within normal limits), though biomarker negativity in these patients may grow rarer as high-sensitivity biomarker tests become more widely Chest Pain-Possible Acute Coronary Syndrome Radiography Chest Chest radiography is primarily used for ruling out conditions that may masquerade as acute myocardial ischemia as well as defining secondary findings that may accompany acute MI. Acute pulmonary edema can be seen on chest radiographs without enlargement of the cardiac silhouette in patients with acute MI and no prior history of ischemic damage or associated mitral valve disease. Although chest radiography is insufficient to confirm or exclude the presence of significant CAD, it may be useful in demonstrating clinically important pathology in a significant minority of ACS-suspected patients [31].
Chest Pain Possible Acute Coronary Syndrome PCAs. Noncontrast angiographic whole-heart acquisition with 3-D steady-state free precession MRI technique can provide imaging of the coronary arteries and is particularly useful in the evaluation of coronary anomalies, bypass graft assessment, and coronary aneurysm formation [133]. Trials have demonstrated high sensitivity and moderate specificity of coronary MRA for the evaluation of obstructive coronary artery stenosis, particularly when used in combination with nonangiographic CMR sequences [119,134]. Future avenues of clinical use include reliable evaluation of coronary artery stenosis and characterization of plaque composition for the identification of vulnerable or high-risk plaques [135]. In patients without ST-segment elevation, positive cardiac biomarkers may nonetheless suggest myocardial necrosis, and the ECG may demonstrate a NSTE ischemic pattern, including ST depression, transient ST-segment elevation, or prominent T-wave inversions [139]. ACS patients with unstable angina may have similar ECG patterns but demonstrate no biomarker evidence of myocardial necrosis (eg, troponin level within normal limits), though biomarker negativity in these patients may grow rarer as high-sensitivity biomarker tests become more widely Chest Pain-Possible Acute Coronary Syndrome Radiography Chest Chest radiography is primarily used for ruling out conditions that may masquerade as acute myocardial ischemia as well as defining secondary findings that may accompany acute MI. Acute pulmonary edema can be seen on chest radiographs without enlargement of the cardiac silhouette in patients with acute MI and no prior history of ischemic damage or associated mitral valve disease. Although chest radiography is insufficient to confirm or exclude the presence of significant CAD, it may be useful in demonstrating clinically important pathology in a significant minority of ACS-suspected patients [31].