Cardiovascular Multidetector CT Angiography by Raman, Subha

By Raman, Subha

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Positive vessel wall remodeling also known as the Glagov phenomenon, which is associated with increased risk of plaque rupture, may be identified and quantified noninvasively with coronary CTA. CTA can readily delineate 3-D graft anatomy with volume rendering as well as graft patency with two-dimensional (2-D) image reconstruction. Prior to revascularization, suitable conduits such as the internal mammary arteries can be visualized with CTA. In patients who require repeat surgical revascularization, CTA can provide measurements of the distance from the chest well to the most anterior conduit such as a LIMA anastomosed to an LAD.

38). 38 Patent stent in the first obtuse marginal branch of the circumflex coronary artery (arrow). CLINICAL CASE 14 A 74-year-old female with hypertension, hyperlipidemia, and CAD status post circumflex artery stent placement presented for chest pain evaluation. CTA showed patency of the proximal circumflex artery stent (Fig. 39). 39 Patent proximal left circumflex coronary artery stent (arrow). 1182 Chap03 5/14/07 32 6:07 PM Page 32 CARDIOVASCULAR MULTIDETECTOR CT ANGIOGRAPHY CORONARY ARTERY ECTASIA CLINICAL CASE 15 A 58-year-old male with an implantable cardiac defibrillator for ventricular tachycardia presented for evaluation of dyspnea.

In light of this history, he was referred for noninvasive CTA. CTA redemonstrated that the mid-LAD took a short intramyocardial course (Fig. 54). 54 CTA reformatted in an oblique sagittal plane demonstrates a short intramyocardial segment of the mid-left anterior descending coronary artery (arrow) that appeared most pronounced during systole. Note the relative graininess of the image due to obesity combined with ECG dose modulation that reduced the dose applied during systole. An alternative approach when bridging is suspected a priori is to not apply ECG dose modulation.

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