Circulation. 2005;112:e343-e344
doi: 10.1161/CIRCULATIONAHA.105.545970
(Circulation. 2005;112:e343-e344.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Multislice Computed Tomography and Magnetic Resonance Imaging
Complementary Use in Noninvasive Coronary Angiography
Christoph Langer, MD;
Marcus Wiemer, MD;
Andreas Peterschröder, MD;
Krista Franzke, MD;
Hans Meyer, MD;
Dieter Horstkotte, MD
From the Department of Cardiology (C.L., M.W., K.F., D.H.) and the Department of Congenital Heart Defects (A.P., H.M.), Heart Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Correspondence to Christoph Langer, MD, Heart Center North Rhine-Westphalia, Department of Cardiology, Georgstrasse 11, 32545 Bad Oeynhausen, Germany. E-mail clanger{at}hdz-nrw.de
A 68-year-old woman with a relevant cardiovascular risk profile presented with atypical chest pain. Ergometric exercise demonstrated an insignificant ST-segment deviation in the precordial leads and premature beats increasing in frequency during exercise.
Calcium scoring by multislice computed tomography (MSCT; Sensation Cardiac) revealed a very high calcium volume score of 3639 mm3, a mass score of 1005.88 mg calcium hydroxyapatite, and an Agatston score equivalent1 of 4648.9. Because of this severe coronary calcification, subsequent contrast-enhanced, MSCT-based angiography failed to demonstrate the coronary lumina and to detect significant stenosis of the right coronary artery (Figure 1). Not being sensitive for but "filtering" calcification, magnetic resonance imaging (MRI)–based coronary angiography (1.5 T; balanced turbo field echo) detected a high-grade stenosis of the mid right coronary artery (Figure 2), which was confirmed by invasive coronary angiography as the reference standard (Figure 3).
View larger version (33K):
[in this window]
[in a new window]
|
Figure 1. Contrast-enhanced, MSCT-based angiography of the heart in the left anterior oblique view, which was unable to detect a stenotic lesion of the severely calcified right coronary artery. A, Multiplanar reformatted view; B, maximum-intensity projection (3-mm slices); C, volume rendering.
|
|
View larger version (160K):
[in this window]
[in a new window]
|
Figure 2. MRI-based coronary angiography (3-dimensional balanced turbo field echo) in the left anterior oblique view, demonstrating significant stenosis (arrow) of the right coronary artery.
|
|
View larger version (161K):
[in this window]
[in a new window]
|
Figure 3. Coronary angiogram in the left anterior oblique pro-jection illustrates an ulcerated, eccentric, calcified lesion (arrow) with intraluminal haziness of the mid right coronary artery.
|
|
Contrast-enhanced MSCT is an established technique in noninvasive coronary angiography.2 However, detection of significant coronary stenoses can be limited by marked calcification.1 As reported here, there are cases in which MRI-based coronary angiography is superior to CT by excluding calcification. In noninvasive coronary angiography, MSCT and MRI may be used complementarily.
 |
Disclosures
|
|---|
None.
|
References
|
|---|
- Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, Claussen CD, Kopp AF, Schroeder S. Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. J Am Coll Cardiol. 2005; 45: 123–127.[Abstract/Free Full Text]
- Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, Schlundt C, Bautz W, Daniel WG, Achenbach S. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation. 2003; 107: 664–666.[Abstract/Free Full Text]
Related Article:
-
Issue Highlights
Circulation 2005 112: 3535.
[Full Text]
Top
Disclosures
References