Skip to main content
SpringerLink
Log in

„Triple-rule-out“-Computertomographie in der Notaufnahme

Triple rule-out computed tomography in emergency departments

  • Leitthema
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

In den Notaufnahmen spielen Patienten mit Brustschmerzen eine wichtige Rolle, da sich dahinter mehrere lebensbedrohliche Erkrankungen verbergen können. Häufig sind die Beschwerden nicht richtungweisend, bzw. die Patienten haben unterschiedliche Riskoprofile. Bei einem Patienten mit unspezifischem Thoraxschmerz in der Notaufnahme ist die „Einstoppstrategie“ zur Abklärung der 3 Hauptorgane Herz, Lunge und Aorta mit den 4 Hauptdifferenzialdiagnosen (Aortendissektion, Ruptur eines Aortenaneurysmas, Lungenembolie oder koronare Herzerkrankung) wünschenswert. Technische Fortschritte der Computertomographie (CT) in den letzten Jahren machen dieses Vorgehen technisch möglich. In modernen Notaufnahmen finden sich auch immer häufiger CT-Geräte, um Traumapatienten rasch zu versorgen. Die sinnvolle Patientenselektion und -vorbereitung sind jedoch notwendig, um eine unnötige Belastung der Patienten mit Kontrastmittel und Röntgenstrahlen zu vermeiden. So ist es möglich, die Rate an übersehenen Erkrankungen oder Fehldiagnosen zu reduzieren.

Abstract

In the emergency department patients with chest pain play an important role because the underlying and concealed diseases can be life-threatening. The complaints are often nonspecific and patients also have different risk profiles. In patients in the emergency department with nonspecific chest pain a“1-stop strategy” for elucidation of the three main organs lung, hear and aorta with the 4 main differential diagnoses (aortic dissection, ruptured aortic aneurysm, pulmonary embolism and coronary heart disease) is desirable. Technical advances in computed tomography (CT) in recent years make this approach technically possible. In modern emergency departments CT equipment is becoming more and more common in order to rapidly examine trauma patients. A meaningful patient selection and preparation are, however, necessary to avoid unnecessary exposure of patients to contrast media and radiation. In this way it is possible to reduce the rate of overlooked diseases or false diagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Bamberg F, Marcus R, Sommer W et al (2010) Diagnostic image quality of a comprehensive high-pitch dual-spiral cardiothoracic CT protocol in patients with undifferentiated acute chest pain. Eur J Radiol, doi 10.1016/j.ejrad.2010.11.032

  2. Bastarrika G, Thilo C, Headden GF et al (2009) Cardiac CT in the assessment of acute chest pain in the emergency department. AJR Am J Roentgenol 193:397–409

    Article  PubMed  Google Scholar 

  3. Berrington De Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351

    Article  Google Scholar 

  4. Betsou S, Efstathopoulos EP, Katritsis D et al (1998) Patient radiation doses during cardiac catheterization procedures. Br J Radiol 71:634–639

    PubMed  CAS  Google Scholar 

  5. Breuckmann F, Post F, Giannitsis E et al (2008) Kriterien der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung für „Chest-Pain-Units“. Kardiologe 2:389–394

    Article  Google Scholar 

  6. Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732

    Article  PubMed  Google Scholar 

  7. Deutscher Bundestag (2007) Unterrichtung durch die Bundesregierung. Umweltradioaktivität und Strahlenbelastung im Jahr 2006. BT-Drucks 16/6835. http://dipbt.bundestag.de/dip21/btd/16/068/1606835.pdf. Zugegriffen 19 September 2011

  8. Halpern EJ (2009) Triple-rule-out CT angiography for evaluation of acute chest pain and possible acute coronary syndrome. Radiology 252:332–345

    Article  PubMed  Google Scholar 

  9. Hamm CW, Albrecht A, Bonzel T et al (2008) Diagnostische Herzkatheteruntersuchung. Clin Res Cardiol 97:475–512

    Article  PubMed  CAS  Google Scholar 

  10. Hausleiter J, Meyer T, Hermann F et al (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301:500–507

    Article  PubMed  CAS  Google Scholar 

  11. Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461

    Article  PubMed  Google Scholar 

  12. Johnson TR, Nikolaou K, Becker A et al (2008) Dual-source CT for chest pain assessment. Eur Radiol 18:773–780

    Article  PubMed  Google Scholar 

  13. Karcz A, Korn R, Burke MC et al (1996) Malpractice claims against emergency physicians in Massachusetts: 1975–1993. Am J Emerg Med 14:341–345

    Article  PubMed  CAS  Google Scholar 

  14. Ketelsen D, Fenchel M, Thomas C et al (2011) Estimation of radiation exposure of retrospective gated and prospective triggered 128-slice triple-rule-out CT angiography. Acta Radiol 52:762–766

    Article  PubMed  Google Scholar 

  15. Ladapo JA, Hoffmann U, Bamberg F et al (2008) Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain. AJR Am J Roentgenol 191:455–463

    Article  PubMed  Google Scholar 

  16. Lee HY, Yoo SM, White CS (2009) Coronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography. Int J Cardiovasc Imaging 25:319–326

    Article  PubMed  Google Scholar 

  17. Lee TH, Goldman L (2000) Evaluation of the patient with acute chest pain. N Engl J Med 342:1187–1195

    Article  PubMed  CAS  Google Scholar 

  18. Madder RD, Raff GL, Hickman L et al (2011) Comparative diagnostic yield and 3-month outcomes of „triple rule-out“ and standard protocol coronary CT angiography in the evaluation of acute chest pain. J Cardiovasc Comput Tomogr 5:165–171

    Article  PubMed  Google Scholar 

  19. Meijboom WB, Van Mieghem CA, Mollet NR et al (2007) 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol 50:1469–1475

    Article  PubMed  Google Scholar 

  20. Mitsumori LM, Wang E, May JM et al (2010) Triphasic contrast bolus for whole-chest ECG-gated 64-MDCT of patients with nonspecific chest pain: evaluation of arterial enhancement and streak artifact. AJR Am J Roentgenol 194:W263–W271

    Article  PubMed  Google Scholar 

  21. Pitts SR, Niska RW, Xu J et al (2008) National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report 7:1–38

    PubMed  Google Scholar 

  22. Ryu JH, Swensen SJ, Olson EJ et al (2001) Diagnosis of pulmonary embolism with use of computed tomographic angiography. Mayo Clin Proc 76:59–65

    Article  PubMed  CAS  Google Scholar 

  23. Schull MJ, Vermeulen MJ, Stukel TA (2006) The risk of missed diagnosis of acute myocardial infarction associated with emergency department volume. Ann Emerg Med 48:647–655

    Article  PubMed  Google Scholar 

  24. Shuman WP, Branch KR, May JM et al (2009) Whole-chest 64-MDCT of emergency department patients with nonspecific chest pain: radiation dose and coronary artery image quality with prospective ECG triggering versus retrospective ECG gating. AJR Am J Roentgenol 192:1662–1667

    Article  PubMed  Google Scholar 

  25. Stein EG, Haramati LB, Chamarthy M et al (2010) Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department. AJR Am J Roentgenol 194:392–397

    Article  PubMed  Google Scholar 

  26. Stillman AE, Oudkerk M, Ackerman M et al (2007) Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Eur Radiol 17:2196–2207

    Article  PubMed  Google Scholar 

  27. Szucs-Farkas Z, Strautz T, Patak MA et al (2009) Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients. Eur Radiol 19:1914–1922

    Article  PubMed  Google Scholar 

  28. Takakuwa KM, Halpern EJ, Gingold EL et al (2009) Radiation dose in a „triple rule-out“ coronary CT angiography protocol of emergency department patients using 64-MDCT: the impact of ECG-based tube current modulation on age, sex, and body mass index. AJR Am J Roentgenol 192:866–872

    Article  PubMed  Google Scholar 

  29. Thomas J, Rideau AM, Paulson EK et al (2008) Emergency department imaging: current practice. J Am Coll Radiol 5:811–816e812

    Article  PubMed  Google Scholar 

  30. Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R et al (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428

    Article  PubMed  Google Scholar 

  31. Vrachliotis TG, Bis KG, Haidary A et al (2007) Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography. Radiology 243:368–376

    Article  PubMed  Google Scholar 

  32. Willoteaux S, Lions C, Gaxotte V et al (2004) Imaging of aortic dissection by helical computed tomography (CT). Eur Radiol 14:1999–2008

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Diagnostische Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland

    D. Stoevesandt

  2. Universitätsklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland

    M. Buerke

Authors
  1. D. Stoevesandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Buerke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Stoevesandt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stoevesandt, D., Buerke, M. „Triple-rule-out“-Computertomographie in der Notaufnahme. Med Klin 106, 89–95 (2011). https://doi.org/10.1007/s00063-011-0009-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-011-0009-6

Schlüsselwörter

Keywords

Search

Navigation