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Dual Source CT (DSCT) coronary angiography

Rule out presence of hemodynamically relevant coronary artery stenosis

Author: Stephan Achenbach, MD, Department of Cardiology, University of Erlangen, Germany

History

A 62-year-old patient with atypical chest pain was examined with DSCT coronary angiography to rule out the presence of hemodynamically relevant coronary artery stenosis. No pre-medication with beta blockers was given. The heart rate during data acquisition varied between 61 b/min and 70 b/min. 70/min.


Diagnosis 

Review of the transaxial slices revealed pronounced calcification of the left coronary system (fig. 1) and mild calcification of the right coronary system. However, in spite of the severe calcifications, there were no motion artifacts and the image quality was not impaired at all. In multi-planar reconstructions (fig. 2), it was possible to identify the patient’s lumen without significant stenosis in all segments of the coronary artery system (see also 3D reconstruction, fig. 3).


Comments

In summary, the lack of motion artifacts in a coronary CTA data set with severe calcifications provided for unimpaired diagnostic image quality. Coronary artery stenosis could be reliably ruled out and the patient was treated conservatively. Initial experience with DSCT suggests that overall improvements in image quality as compared to previous scanner generations may substantially improve evaluation and diagnostic accuracy in severely calcified coronary arteries.

 

Massive calcification in the proximal left anterior descending coronary artery.
Oblique multiplanar reconstruction of the proximal left anterior descending coronary artery reveals a patent lumen next to the severe wall calcification.
Pronounced calcification in the proximal left circumflex coronary artery without any artifacts.
Reconstruction of the right coronary artery. Mild calcification no stenosis.
3-dimensional reconstruction of the data set. Heart rate varied between 61 and 70b/min during data acquisition.
3-dimensional reconstruction of the data set. Heart rate varied between 61 and 70b/min during data acquisition.

Examination Protocol

Scanner SOMATOM Definition
Scan area CorCTA
Scan length 138 mm
Scan time 8.2 s
Scan direction Cranio Caudal
Heart rate 61-70 bpm
kV 120
mAs/ Rot 294
Rotation time 0.33 s
Slice collimation 0.6
Slice width 0.75 mm
Pitch 0.28
Reconstruction increment 0.4 mm
Kernel B26f
Volume 10 ml test Bolus/ 50 ml Injection
Flow rate 5 ml/s
Start delay 19 s

Date: 2006-11-16


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