Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,Jianhua Liu,The second hospital,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,According to the latest National Hospital Ambulatory Medical Care Survey, the most common reasons given by adult patients (15 years and older) for visiting the ED were, in descending frequency, chest pain, abdominal pain, back pain, headache, and shortness of breath, with an estimated 6.4 million patient visits for chest pain.,Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: Emergency department summary. National health statistics reports; no 7. Hyattsville, MD: National Center for Health Statistics.www.cdc.gov/nchs. Accessed May 10, 2009,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,The most clinically relevant conditions causing chest pain that have to be differentiated in the ED are pulmonary embolism, acute aortic syndrome, and coronary artery disease presenting as acute coronary syndrome. The last condition is identified in approximately 1525% of patients with acute chest pain who are evaluated in EDs.,Pozen MW, DAgostino RB, Selker HP, Sytkowski PA, Hood WB Jr. A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial. N Engl J Med 1984; 310:12731278,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,Detailed patient history and physical examination,Measurement of cardiac biomarkers,ECG,Chest film,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,Radiology Department,Theory and preparement of CTA,Follow-up of CTA,Diagnosis of CTA,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,Preparement and theory,Preparement and theory,Theory and preparement of CTA,Follow-up of CTA,Diagnosis of CTA,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,CTA with diagnosis,(A) Normal blood flow in the aorta. (B) Dissection occurs when the inner lining of the aorta tears and the blood flow dissects between the layers of the aortic wall.,Copyright 2002 - 2004 Baylor College of Medicine.,An aortic dissection is a tear of the inner lining of the artery.,Typical Aortic Dissection, Intramural Hematoma and Penetrating Aortic Ulcer.,-Aortic dissection,CTA with diagnosis,-Aortic dissection,CTA with diagnosis,-Aortic dissection,CTA with diagnosis,-Aortic dissection,CTA with diagnosis,-Aortic dissection,CTA with diagnosis,-Aortic dissection,CTA with diagnosis,-Aortic dissection,CTA with diagnosis,-Aortic dissection,Case2 of aortic dissection,Case2 of aortic dissection,Case2 of aortic dissection,Case1 of aortic dissection,Case1 of aortic dissection,Case1 of aortic dissection,Case3 of aortic dissection,CTA with diagnosis,CTA with diagnosis-pulmonary embolism,CTA with diagnosis-pulmonary embolism,CTA with diagnosis-pulmonary embolism,CTA with diagnosis-pulmonary embolism,- Ross 1999; Encyclopedia of Medical Images,Endothelial dysfunction,Fatty streak,Fibrofatty lesion,Fibrous plaque,CTA with diagnosis-CAD,Coronary Heart Disease(CHD),Coronary Heart Disease(CHD),Case1 of CAD,Case1 of CAD,A possibility of coronary CT is that the technique can assess the presence of occult atherosclerosis and might develop as a useful tool to screen for early detection of atherosclerosis in asymptomatic subjects. Because CT coronary imaging comprehensively evaluates the composition (calcific and noncalcific) of coronary plaques, it might provide prognostic evidence independent of and incremental to simple CT calcium scoring.,Pim J. de Feyter, Carl J. Schultz. Tomography Coronary Angiography for Screening Asymptomatic Subjects,Journal of the American College of Cardiology 2008;52:3668,Because approximately 50% of all acute coronary syndromes occur in previously asymptomatic subjects, there obviously is a need to identify these subjects before coronary atherosclerosis becomes clinically manifest and irreversible damage occurs by progression to myocardial infarction or cardiac death,Murabito JM, Evans JC, Larson MG, Levy D. Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation. Circulation 1993;88:2548 55.,Theory and preparement of CTA,Follow-up of CTA,Diagnosis of CTA,Application of triple rule-out with 256-slice spiral CT in the diagnosis of acute chest pain,Case1 of aortic dissectionfollow-up,2009.10.9,2009.9.16,Case1 of aortic dissectionfollow-up,2009.10.9,2009.9.16,Case2 of aortic dissectionfollow-up,2009.11.5,2009.9.27,Case2 of aortic dissectionfollow-up,2009.11.5,2009.9.27,