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MDCT Evaluation of the Coronary Arteries, 2004: How We Do It—Data Acquisition, Postprocessing, Display, and Interpretation

¹ All authors: Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St., Rm. 3254, Baltimore, MD 21287-0801.

View larger version (8K): [in a new window]   Fig. 1. —ECG trace shows relative delay method for scan reconstruction. R-R interval is divided into percentage increments from 0% to 100%: 0% at first R wave and 100% at second R wave. Image reconstruction is started with a certain delay from the prior R wave. The delay is defined as a percentage of the R-R interval—for example, 60%.

View larger version (8K): [in a new window]   Fig. 2. —ECG trace shows absolute reverse method for scan reconstruction. Image reconstruction starts at fixed time (in milliseconds) before R wave.

View larger version (34K): [in a new window]   Fig. 3. —Illustration with ECG trace shows how entire volume is reconstructed using single-segment reconstruction. (Courtesy of Corl FM, Baltimore, MD)

View larger version (8K): [in a new window]   Fig. 4. —ECG trace shows how a set of images is reconstructed using data acquired during two cardiac cycles for multisegment reconstruction.

View larger version (72K): [in a new window]   Fig. 5A. —Images of 52-year-old man show stairstep artifact. Coronal multiplanar reconstruction CT image shows stairstep artifact (arrows) in cardiac contour.

View larger version (5K): [in a new window]   Fig. 5B. —Images of 52-year-old man show stairstep artifact. ECG trace shows early R wave(arrowhead). Relative delay method has been used to reconstruct images. Reconstruction is in diastole for first cardiac cycle. Reconstruction overlaps systole for next cycle because of early R wave. Arrow shows start of reconstruction of second image set. ECG trace can be edited to delete this reconstruction. Double-headed arrows show relative delay.

View larger version (32K): [in a new window]   Fig. 6A. —Images of 60-year-old woman show stairstep artifact and effect of editing ECG trace. Coronal multiplanar reconstruction CT image shows stairstep artifact (arrow).

View larger version (117K): [in a new window]   Fig. 6B. —Images of 60-year-old woman show stairstep artifact and effect of editing ECG trace. ECG trace from scan shown in A reveals second reconstruction set for images 13–24 (arrow) overlapping systole. Second and third reconstruction sets are in different points of cardiac cycle. Third reconstruction set is for images 25–31.

View larger version (38K): [in a new window]   Fig. 6C. —Images of 60-year-old woman show stairstep artifact and effect of editing ECG trace. ECG trace shown in B was edited to delete second reconstruction (arrow). Images 13–31 (arrowhead) are now reconstructed from next cardiac cycle.

View larger version (47K): [in a new window]   Fig. 6D. —Images of 60-year-old woman show stairstep artifact and effect of editing ECG trace. Coronal multiplanar reconstruction CT image shows stairstep artifact (arrow) is gone as a result of editing of ECG trace (C).

View larger version (25K): [in a new window]   Fig. 8B. —Images of coronary artery in 56-year-old man obtained using postprocessing techniques. Multiplanar reconstruction CT image shows centerline vessel straightening of right coronary artery (arrowhead).

View larger version (158K): [in a new window]   Fig. 7A. —Coronary artery anatomy in 56-year-old man on 3D MDCT images obtained with volume-rendering technique. Left lateral view shows left anterior descending (arrow) and circumflex (arrowhead) arteries.

View larger version (119K): [in a new window]   Fig. 7B. —Coronary artery anatomy in 56-year-old man on 3D MDCT images obtained with volume-rendering technique. Superior view shows origins of right (arrow) and left (arrowhead) main coronary arteries.

View larger version (159K): [in a new window]   Fig. 7C. —Coronary artery anatomy in 56-year-old man on 3D MDCT images obtained with volume-rendering technique. Anterior view shows right coronary artery (arrow).

View larger version (75K): [in a new window]   Fig. 8A. —Images of coronary artery in 56-year-old man obtained using postprocessing techniques. Coronal multiplanar reconstruction CT image shows right coronary artery (arrowhead).

View larger version (110K): [in a new window]   Fig. 8C. —Images of coronary artery in 56-year-old man obtained using postprocessing techniques. Anterior maximum-intensity-projection image shows right coronary artery (arrowhead).

View larger version (140K): [in a new window]   Fig. 9. —Illustration shows coronary arteries and standard nomenclature. (Courtesy of Corl FM, Baltimore, MD).

View larger version (83K): [in a new window]   Fig. 10A. —54-year-old man with coronary artery disease. Volume-rendered left lateral view shows calcified left anterior descending artery with short segment that has proximal stenosis (arrow) of greater than 50%.

View larger version (89K): [in a new window]   Fig. 10B. —54-year-old man with coronary artery disease. Maximum-intensity-projection image shows left lateral view of calcified left anterior descending artery with short segment that has proximal stenosis (arrow-head) of greater than 50%.

View larger version (106K): [in a new window]   Fig. 11A. —72-year-old woman with coronary artery disease. Coronal volume-rendered view (A) and coronal maximum-intensity-projection view (B) show stenosis (arrowhead) of greater than 70% that is due to focal noncalcified plaque in proximal right coronary artery (arrow).

View larger version (121K): [in a new window]   Fig. 11B. —72-year-old woman with coronary artery disease. Coronal volume-rendered view (A) and coronal maximum-intensity-projection view (B) show stenosis (arrowhead) of greater than 70% that is due to focal noncalcified plaque in proximal right coronary artery (arrow).

View larger version (112K): [in a new window]   Fig. 12. —63-year-old man with coronary artery disease. Right sagittal maximum-intensity-projection image of left anterior descending artery shows focal inferior eccentric calcification (arrow).

View larger version (99K): [in a new window]   Fig. 13A. —60-year-old man undergoing assessment after coronary artery bypass grafting. Volume-rendered anterior view shows saphenous vein bypass grafts (arrowheads) from aneurysmal aorta (A) and left internal mammary bypass graft (arrow).

View larger version (120K): [in a new window]   Fig. 13B. —60-year-old man undergoing assessment after coronary artery bypass grafting. Volume-rendered left lateral view shows saphenous vein (arrowhead) and left internal mammary (arrow) bypass grafts.

View larger version (179K): [in a new window]   Fig. 14A. —30-year-old woman referred for evaluation of aberrant coronary artery origin. Volume-rendered superior oblique image shows common origin of aberrant right (short arrow) and left main (arrowhead) coronary arteries from left aortic sinus. Note left anterior descending coronary artery (long arrow).

View larger version (118K): [in a new window]   Fig. 14B. —30-year-old woman referred for evaluation of aberrant coronary artery origin. Maximum-intensity-projection superior oblique view shows common origin of aberrant right (arrowhead) and left main (arrow) coronary arteries from left aortic sinus.

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