One specialized protocol of coronary CTA is the triple rule out examination, which uses a specific contrast acquisition scanning protocol to enable assessment of the pulmonary arteries, the aorta and the coronary arteries [37]. For the purpose of this document, the triple rule out is considered part of the CTA coronary arteries. CT Chest Without IV Contrast Noncontrast chest CT can assess for the presence of a pericardial effusion, epipericardial fat necrosis, and other noncardiac causes of chest pain. There is no relevant literature to support the use of CT chest without IV contrast in the evaluation of acute nonspecific chest pain with low probability of CAD as an initial imaging test. CT Chest With IV Contrast Noncontrast chest CT can assess for the presence of a pericarditis, epipericardial fat necrosis, and other noncardiac causes of chest pain. There is no relevant literature to support the use of CT chest with IV contrast in the evaluation of acute nonspecific chest pain with low probability of CAD as an initial imaging test. CT Chest Without and With IV Contrast Chest CT without and with IV contrast as a follow-up to a suspicious finding suggested by radiographs of the chest is typically not used [20,38]. There is no relevant literature to support the use of CT chest without and with IV contrast in the initial imaging evaluation of acute nonspecific chest pain with low probability of CAD. CT Heart Function and Morphology With IV Contrast In a single-center retrospective analysis of 225 patients, heart morphology and function indexes, as a derivative of a CCTA study, have been shown to correlate with MACE at 13 months [39]. There is no relevant literature to support use of this test as an initial imaging strategy. See the CTA coronary arteries section above for coronary artery assessment.
Acute Nonspecific Chest Pain Low Probability of Coronary Artery Disease PCAs. One specialized protocol of coronary CTA is the triple rule out examination, which uses a specific contrast acquisition scanning protocol to enable assessment of the pulmonary arteries, the aorta and the coronary arteries [37]. For the purpose of this document, the triple rule out is considered part of the CTA coronary arteries. CT Chest Without IV Contrast Noncontrast chest CT can assess for the presence of a pericardial effusion, epipericardial fat necrosis, and other noncardiac causes of chest pain. There is no relevant literature to support the use of CT chest without IV contrast in the evaluation of acute nonspecific chest pain with low probability of CAD as an initial imaging test. CT Chest With IV Contrast Noncontrast chest CT can assess for the presence of a pericarditis, epipericardial fat necrosis, and other noncardiac causes of chest pain. There is no relevant literature to support the use of CT chest with IV contrast in the evaluation of acute nonspecific chest pain with low probability of CAD as an initial imaging test. CT Chest Without and With IV Contrast Chest CT without and with IV contrast as a follow-up to a suspicious finding suggested by radiographs of the chest is typically not used [20,38]. There is no relevant literature to support the use of CT chest without and with IV contrast in the initial imaging evaluation of acute nonspecific chest pain with low probability of CAD. CT Heart Function and Morphology With IV Contrast In a single-center retrospective analysis of 225 patients, heart morphology and function indexes, as a derivative of a CCTA study, have been shown to correlate with MACE at 13 months [39]. There is no relevant literature to support use of this test as an initial imaging strategy. See the CTA coronary arteries section above for coronary artery assessment.