CASE 1966 Published on 11.08.2003

Pre- and post-operative evaluation of coronary artery disease with triple vessel lesions using MDCT

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Fukuda T, Hamada S, Murai S, Nakamura H

Patient

66 years, male

Categories
No Area of Interest ; Imaging Technique CT, CT, CT, CT, CT
Clinical History
Unstable angina
Imaging Findings
This patient presented with a diagnosis of unstable angina. His coronary angiography revealed 90% stenosis in the left descending anterior branch (#6)(Fig. 2), 90% stenosis in the left circumflex branch (#11)(Fig. 3) and 75% stenosis in the right coronary artery (#1)(Fig. 4).
As re-vascularization therapy, CABG was performed: LITA to PL branch, RITA to LAD (#7) and Gastroepiploic arterial graft to RCA (#4)(Fig 5).
The CT scanner used was a GE multi-detector row CT scanner (8 detector row). ECG-gated scans were obtained with the following parameters: 0.5 second per rotation, 1.25 mm detector thickness, pitch 1.35. A contrast material containing 350 mg of iodine per milliliter (Iohexol, Daiichi-pharmacy, Japan) was injected into an antecubital vein at a rate of 3ml/sec. Scan delay time was 30 seconds. Axial images were reconstructed with Half scan algorithm (Fig. 1).
Discussion
The introduction of multidetector-row computed tomography (MDCT) scanners permits the visualization of coronary artery lumen after intravenous injection of contrast agent. Several reports demonstrate that MDCT with retrospective ECG gating permits the detection of coronary artery stenosis and occlusions with high sensitivity and specificity (1, 2). Although we must verify these results by further refinement, this approach will be clinically useful, because of a noninvasive method. Compared with coronary angiogram, curved MPR images of our case correctly identified coronary stenosis. After the revascularization, patency of coronary bypass graft of our case was also evaluated. General drawbacks of MDCT for coronary visualization are radiation dose and the administration of contrast media. However, MDCT coronary angiogram offers additional information about the characteristics of vessel wall, like atheromatous plaques (3).
Differential Diagnosis List
Coronary arteries bypass graft (CABG) for Triple Vessel Disease
Final Diagnosis
Coronary arteries bypass graft (CABG) for Triple Vessel Disease
Case information
URL: https://www.eurorad.org/case/1966
DOI: 10.1594/EURORAD/CASE.1966
ISSN: 1563-4086