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Noninvasive Evaluation of Cardiac Veins with 16-MDCT Angiography

¹ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, CIMIT, 100 Charles River Plaza, Ste. 400, Boston, MA 02114.
² Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114.
³ Present address: Department of Internal Medicine II (Cardiology), University of Erlangen-Nuremberg, Erlangen 91054, Germany.

View larger version (10K): [in a new window]   Fig. 1 —Box-and-whisker plot shows median, upper median, lower median, smallest, and largest conspicuity values (0, vein not visible, to 10, excellent visualization) for analyzed cardiac venous segments. CS = coronary sinus, MCV = middle cardiac vein, PV = posterior vein of left ventricle, LV = lateral (marginal) vein, GCV = great cardiac vein, AIV = anterior interventricular vein.

View larger version (11K): [in a new window]   Fig. 2 —Box-and-whisker plot shows median, upper median, lower median, smallest, and largest contrast-to-noise ratio values for analyzed cardiac venous segments. CS = coronary sinus, MCV = middle cardiac vein, PV = posterior vein of left ventricle, LV = lateral (marginal) vein, GCV great cardiac vein, AIV = anterior interventricular vein.

View larger version (11K): [in a new window]   Fig. 3 —Scatterplot illustrates relation between conspicuity (0, vein not visible, to 10, excellent visualization) and contrast-to-noise ratio in 134 cardiac vein segments. Significant positive correlation is seen between conspicuity and measured contrast-to-noise ratio (p < 0.0001; nonparametric two-tailed Spearman's r = 0.48 [95% confidence interval = 0.34-0.61]).

View larger version (96K): [in a new window]   Fig. 4A —81-year-old woman with atypical chest pain. Three-dimensional volume-rendered reformations (A and B) and multiplanar maximum intensity projections along marginal left ventricular vein (C), in left ventricular long axis (D), in mitral-tricuspid valve plane (E), and along anterior interventricular vein (F) show large marginal vein (black arrows, A and C) and absence of posterior vein of left ventricle. Coronary sinus (open arrows, A, C, D, E), middle cardiac vein (arrowheads, A, C, D), and great cardiac vein (curved arrows, A and B) are well opacified. Anterior interventricular vein (straight white arrows, B and F) has lower contrast concentration because it is imaged several heartbeats earlier.

View larger version (90K): [in a new window]   Fig. 4B —81-year-old woman with atypical chest pain. Three-dimensional volume-rendered reformations (A and B) and multiplanar maximum intensity projections along marginal left ventricular vein (C), in left ventricular long axis (D), in mitral-tricuspid valve plane (E), and along anterior interventricular vein (F) show large marginal vein (black arrows, A and C) and absence of posterior vein of left ventricle. Coronary sinus (open arrows, A, C, D, E), middle cardiac vein (arrowheads, A, C, D), and great cardiac vein (curved arrows, A and B) are well opacified. Anterior interventricular vein (straight white arrows, B and F) has lower contrast concentration because it is imaged several heartbeats earlier.

View larger version (134K): [in a new window]   Fig. 4C —81-year-old woman with atypical chest pain. Three-dimensional volume-rendered reformations (A and B) and multiplanar maximum intensity projections along marginal left ventricular vein (C), in left ventricular long axis (D), in mitral-tricuspid valve plane (E), and along anterior interventricular vein (F) show large marginal vein (black arrows, A and C) and absence of posterior vein of left ventricle. Coronary sinus (open arrows, A, C, D, E), middle cardiac vein (arrowheads, A, C, D), and great cardiac vein (curved arrows, A and B) are well opacified. Anterior interventricular vein (straight white arrows, B and F) has lower contrast concentration because it is imaged several heartbeats earlier.

View larger version (107K): [in a new window]   Fig. 4D —81-year-old woman with atypical chest pain. Three-dimensional volume-rendered reformations (A and B) and multiplanar maximum intensity projections along marginal left ventricular vein (C), in left ventricular long axis (D), in mitral-tricuspid valve plane (E), and along anterior interventricular vein (F) show large marginal vein (black arrows, A and C) and absence of posterior vein of left ventricle. Coronary sinus (open arrows, A, C, D, E), middle cardiac vein (arrowheads, A, C, D), and great cardiac vein (curved arrows, A and B) are well opacified. Anterior interventricular vein (straight white arrows, B and F) has lower contrast concentration because it is imaged several heartbeats earlier.

View larger version (124K): [in a new window]   Fig. 4E —81-year-old woman with atypical chest pain. Three-dimensional volume-rendered reformations (A and B) and multiplanar maximum intensity projections along marginal left ventricular vein (C), in left ventricular long axis (D), in mitral-tricuspid valve plane (E), and along anterior interventricular vein (F) show large marginal vein (black arrows, A and C) and absence of posterior vein of left ventricle. Coronary sinus (open arrows, A, C, D, E), middle cardiac vein (arrowheads, A, C, D), and great cardiac vein (curved arrows, A and B) are well opacified. Anterior interventricular vein (straight white arrows, B and F) has lower contrast concentration because it is imaged several heartbeats earlier.

View larger version (100K): [in a new window]   Fig. 4F —81-year-old woman with atypical chest pain. Three-dimensional volume-rendered reformations (A and B) and multiplanar maximum intensity projections along marginal left ventricular vein (C), in left ventricular long axis (D), in mitral-tricuspid valve plane (E), and along anterior interventricular vein (F) show large marginal vein (black arrows, A and C) and absence of posterior vein of left ventricle. Coronary sinus (open arrows, A, C, D, E), middle cardiac vein (arrowheads, A, C, D), and great cardiac vein (curved arrows, A and B) are well opacified. Anterior interventricular vein (straight white arrows, B and F) has lower contrast concentration because it is imaged several heartbeats earlier.

View larger version (144K): [in a new window]   Fig. 5A —Three patients with atypical chest pain. Cardiac-gated MDCT scans with multiplanar maximum intensity projections show thebesian valve at coronary sinus ostium (arrow) in 52-year-old man (A) and anterior cardiac vein draining directly into right atrium after crossing right coronary artery in atrioventricular groove (arrows) in 49-year-old man (B).

View larger version (147K): [in a new window]   Fig. 5B —Three patients with atypical chest pain. Cardiac-gated MDCT scans with multiplanar maximum intensity projections show thebesian valve at coronary sinus ostium (arrow) in 52-year-old man (A) and anterior cardiac vein draining directly into right atrium after crossing right coronary artery in atrioventricular groove (arrows) in 49-year-old man (B).

View larger version (135K): [in a new window]   Fig. 5C —Three patients with atypical chest pain. Volume-rendered image of inferior cardiac surface shows small cardiac vein (solid arrows) draining into middle cardiac vein (arrowhead) in 63-year-old woman. Note coronary sinus (open arrow).

View larger version (139K): [in a new window]   Fig. 6 —58-year-old man with atypical chest pain. Multiple projections of vessel centerline reconstruction show uninterrupted visibility of vein on cardiac surface over distance of 17.6 cm. Note coronary sinus (open arrow), great cardiac vein (solid arrows), anterior interventricular vein (curved arrow), ostia (arrowheads) of middle cardiac vein (MCV), posterior left ventricular vein (PV), and marginal (lateral) vein (MV). LAA = left atrial appendage, LA = left atrium, LV = left ventricle.

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