CTA Chest CTA of the chest has a well-established role for evaluating other etiologies that may mimic ACS, such as aortic dissection, acute pericarditis, pneumonia, and pneumothorax [27,103]. Nongated chest CTA intended to evaluate a patient for aortic dissection or pulmonary embolism may depict incidental coronary artery pathology, such as anomalous coronary arteries, obstructive CAD, and involvement of the coronary arteries by aortic dissection [104]. In particular, CTA for aortic dissection or pulmonary embolism may be performed with ECG-gating without specific intent to evaluate the coronary arteries (ie, gating intended to reduce pulsation artifact in the great vessels but the examination not otherwise tailored to the coronary arteries), and in those cases, coronary abnormalities may be even more readily apparent as an unexpected finding. Therefore, there is insufficient evidence to support nongated (or incidentally gated) CTA for the evaluation of ACS. Rb-82 PET/CT Heart A stress PET examination can reliably demonstrate myocardial blood flow using rubidium-82 (Rb-82) or nitrogen- 13 (N-13) ammonia. Limited data are available for PET perfusion studies in the setting of acute chest pain, although there is growing evidence for diagnostic and prognostic applications in chronic coronary disease [105,106]. PET can also document anaerobic metabolism using fluorine-18-2-fluoro-2-deoxy-D-glucose and other metabolic tracers. This technology is less well studied in the workup of the acute chest pain patient but may have a role when combined with CTA [105,107,108]. Meta-analysis has shown PET to demonstrate excellent diagnostic performance when compared with other methods of evaluating ischemic myocardium [109].
Chest Pain Possible Acute Coronary Syndrome PCAs. CTA Chest CTA of the chest has a well-established role for evaluating other etiologies that may mimic ACS, such as aortic dissection, acute pericarditis, pneumonia, and pneumothorax [27,103]. Nongated chest CTA intended to evaluate a patient for aortic dissection or pulmonary embolism may depict incidental coronary artery pathology, such as anomalous coronary arteries, obstructive CAD, and involvement of the coronary arteries by aortic dissection [104]. In particular, CTA for aortic dissection or pulmonary embolism may be performed with ECG-gating without specific intent to evaluate the coronary arteries (ie, gating intended to reduce pulsation artifact in the great vessels but the examination not otherwise tailored to the coronary arteries), and in those cases, coronary abnormalities may be even more readily apparent as an unexpected finding. Therefore, there is insufficient evidence to support nongated (or incidentally gated) CTA for the evaluation of ACS. Rb-82 PET/CT Heart A stress PET examination can reliably demonstrate myocardial blood flow using rubidium-82 (Rb-82) or nitrogen- 13 (N-13) ammonia. Limited data are available for PET perfusion studies in the setting of acute chest pain, although there is growing evidence for diagnostic and prognostic applications in chronic coronary disease [105,106]. PET can also document anaerobic metabolism using fluorine-18-2-fluoro-2-deoxy-D-glucose and other metabolic tracers. This technology is less well studied in the workup of the acute chest pain patient but may have a role when combined with CTA [105,107,108]. Meta-analysis has shown PET to demonstrate excellent diagnostic performance when compared with other methods of evaluating ischemic myocardium [109].