The imaging of acute chest pain with multidetector computed tomography

•. Current methods used to assess acute chest pain are inefficient. •. Evidence shows targeted cardiac CT scanning of low- and intermediate-risk patients with acute chest pain is safe, efficient and cost-effective. •. Although highly sensitive to coronary artery disease, its low specificity (relative to invasive angiography) means it should not yet be considered a non-invasive angiogram. •. CT is the gold standard in imaging acute aortic syndrome and pulmonary thromboembolic disease. •. “Triple rule-out” CT scans should be reserved for special situations owing to the increased radiation dose. •. Future technological developments could allow us to image anatomical configuration of arterial plaques, plaque vulnerability and myocardial perfusion. Patients with acute chest pain commonly present to the accident and emergency department and often present a diagnostic conundrum. Current standards of care using cardiac biomarkers and stress testing are time-consuming and often inconclusive. Cardiac CT angiography (CCTA) is emerging as a method to non-invasively image the coronary arteries. The purpose of this paper is to review the evidence as to whether CCTA has a role in evaluating patients with acute chest pain. After assessing the pivotal role CT plays in imaging patients with acute aortic syndrome and pulmonary thromboembolic disease, consideration will also be given to whether it could and should be used to assess the aorta and pulmonary and coronary arteries simultaneously — the so-called “triple rule-out” scan.