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Coronary CT Angiography^*

¹ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and ² Harvard School of Public Health, Boston Massachusetts

View larger version (98K): [in a new window]   FIGURE 1.  (A) Anteroposterior topogram showing volume coverage (field of view) required for dedicated coronary CTA (yellow box) and reading of incidental findings (red box). For coronary CTA, field of view extends from below tracheal bifurcation to base of heart. (B) Timing bolus image acquisition. Images at level of carina are acquired every 2 s starting 10 s after injection of 20 mL of iodinated contrast material. Arrowheads show passage of contrast material through superior vena cava (SVC) at 12 s, pulmonary artery (PA) at 14 s, and ascending aorta (AA) and descending aorta (DA) at 20 s. Coronary CTA scanning was started 20 s after initiation of contrast material injection.

View larger version (27K): [in a new window]   FIGURE 2.  Retrospective ECG-gated reconstruction in patient with sinus rhythm (68 beats per minute), imaged with tube current modulation. White boxes indicate segment of R-R interval from which information will be used to reconstruct axial images. Bold white lines indicate time period of maximum tube current. In this patient, time used for image reconstruction starts at 65% of R-R interval and is well within time of tube current maximum. Tube current modulation should be used in patients with low and regular heart rates.

View larger version (144K): [in a new window]   FIGURE 3.  Patient with normal coronary morphology, as visualized by 64-slice MDCT. (A) Axial CT image was obtained at level of left main (LM) coronary artery ostium, which arises from left sinus of Valsalva and runs posterior to pulmonary artery (PA). LM coronary artery ostium divides into left anterior descending (LAD) and left circumflex (LCX) coronary arteries. A = aorta; LA = left atrium. (B) Axial CT image was obtained through origin of right coronary artery (RCA) at right aortic sinus and running between right ventricular outflow tract and right atrium (RA). Middle and distal segments of LAD coronary artery are located in interventricular groove. LCX coronary artery runs in left atrioventricular groove. (C) Cross-sectional view across midheart plane reveals middle RCA between RA and right ventricle (RV) and middle LAD coronary artery between RV and left ventricle (LV). (D) View of inferior aspect of heart shows posterior descending artery (PDA) arising from RCA running in posterior intraventricular groove.

View larger version (92K): [in a new window]   FIGURE 4.  Stable angina and multiple cardiovascular risk factors in 66-y-old man. Images show detection of significant stenosis of middle segment of left anterior descending coronary artery (LAD) by MDCT and confirmation by coronary angiography. (A) Invasive selective coronary angiography demonstrates mild luminal narrowing in proximal LAD (arrow) and eccentric hemodynamically significant stenosis of middle LAD with residual filiform lumen (arrowhead). (B) Thin-slab MIP image across LAD plane shows large noncalcified plaque causing moderate (0%–30%) luminal obstruction in proximal LAD segment. Complex mixed coronary atherosclerotic plaque in middle LAD segment consists of both calcified plaque and noncalcified plaque, causing highly significant luminal narrowing. (C) 3-Dimensional volume-rendered CT image.

View larger version (83K): [in a new window]   FIGURE 5.  (A) Patient imaged at heart rate of 76 beats per minute. Axial image at level of middle right coronary artery (RCA) demonstrates typical "windmill" appearance of motion artifact (arrowhead). (B) Curved MPR image of entire length of RCA with motion artifact (arrowhead). (C) Patient with multiple extrasystolic beats during image acquisition. Stair-step artifacts (arrows) are caused by irregular rhythm and are best visualized in coronal view. Note that no irregularities occur at sternal border, excluding respiratory motion as cause of artifacts. LV = left ventricle; RV = right ventricle. (D and E) Increasing chest pain on exertion in 70-y-old man. (D) Axial image at level of left main coronary artery ostium and heavily calcified proximal and middle left anterior descending coronary artery. (E) Cross-sectional view at level of proximal left anterior descending coronary artery. Note blooming artifact (arrowhead) caused by vessel calcification, which precludes exclusion of significant coronary artery stenosis.

View larger version (93K): [in a new window]   FIGURE 6.  (A) 3-Dimensional volume-rendered image of patient showing status after left internal mammary graft to middle segment of left anterior descending coronary artery (arrowheads). Operative clips are visualized parallel to course of graft. In addition, venous coronary bypass graft can be seen between aorta and left circumflex coronary artery (arrows). (B) Curved MPR image with sharp image filter reconstruction of right coronary artery in patient with percutaneous stent placement (arrowhead). Lumen of stent (3.5-mm diameter) is patent. There is no evidence of in-stent restenosis or neointimal hyperplasia. In addition, this patient has large noncalcified plaque that protrudes into lumen of proximal right coronary artery, causing significant stenosis (arrow).