Limitations of multidetector computed tomography (MDCT)

doi:10.1136/bmj.a1402

Published 27 August 2008, doi:10.1136/bmj.a1402
Cite this as: BMJ 2008;337:a1402

Letters

Severe interscapular pain

Limitations of multidetector computed tomography (MDCT)

The first 150 words of the full text of this article appear below.

Haydar et al recommend wider adoption of multidetector computedtomography (MDCT) to investigate acute interscapular chest pain.¹Although the potential to confirm or exclude acute myocardialinfarction, aortic dissection, aortitis, or acute pulmonaryembolism in a single radiological study is highly appealing,they did not mention potential hazards or limitations.

Firstly, thorough clinical history and examination should, inmost cases, allow determination of the most likely cause ofthoracic chest pain without the need for "triple rule-out" byMDCT. To obtain MDCT images of sufficient quality to allow this,the heart rate must be slowed pharmacologically to less than65 beats a minute. This may be difficult in patients with acutepain and inadvisable in the presence of acute pulmonary oedema.Above 65 beats a minute, the ability of MDCT to reliably determinethe presence and absence of coronary disease is severely limited.²

Secondly, despite its limitations, transthoracic echocardiographyis . . . [Full text of this article]

Edward D Nicol, specialist registrar, cardiology¹, James Stirrup, cardiac imaging fellow²

¹ John Radcliffe Hospital, Oxford OX3 9DU, ² Royal Brompton Hospital, London SW3 6NP

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