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16-MDCT Coronary Angiography Versus Invasive Coronary Angiography in Acute Chest Pain Syndrome: A Blinded Prospective Study

Eduard Ghersin1, Diana Litmanovich1, Robert Dragu2, Shmuel Rispler2, Jonathan Lessick2, Amos Ofer1, Olga R. Brook1, Luis Gruberg2, Rafael Beyar2 and Ahuva Engel1

1 Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel.
2 Department of Cardiology, Rambam Medical Center, Haifa, Israel.



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  		Fig. 1A —Two patients with unstable angina pectoris. 45-year-old man. Stepladder artifacts caused by respiratory motion. Sagittal maximum-intensity-projection image shows stepladder artifacts affecting both anterior chest wall (solid arrows) and cardiac chambers and great vessels (dotted arrows).

 


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  		Fig. 1B —Two patients with unstable angina pectoris. 70-year-old woman. Stepladder artifacts caused by cardiac motion resulting from faulty ECG gating. Sagittal maximum-intensity-projection image shows stepladder artifacts affecting cardiac chambers and main pulmonary artery (dotted arrows) but not chest wall structures (solid arrow).

 


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  		Fig. 2A —72-year-old man with unstable angina pectoris. Volume-rendered CT angiogram shows stenotic lesion (arrow) in mid left anterior descending coronary.

 


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  		Fig. 2B —72-year-old man with unstable angina pectoris. Corresponding curved planar reformations in two projections (B) and global view of coronary vessel tree (C) show several nonsignificant calcified plaques in left main and proximal left anterior descending (LAD) coronary arteries (dotted arrows) and significant heterogeneous plaque in mid left anterior descending coronary artery (solid arrows) that is causing 60% diameter stenosis. LMCA = left main coronary artery, CRX = circumflex coronary artery, RCA = right coronary artery.

 


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  		Fig. 2C —72-year-old man with unstable angina pectoris. Corresponding curved planar reformations in two projections (B) and global view of coronary vessel tree (C) show several nonsignificant calcified plaques in left main and proximal left anterior descending (LAD) coronary arteries (dotted arrows) and significant heterogeneous plaque in mid left anterior descending coronary artery (solid arrows) that is causing 60% diameter stenosis. LMCA = left main coronary artery, CRX = circumflex coronary artery, RCA = right coronary artery.

 


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  		Fig. 2D —72-year-old man with unstable angina pectoris. Corresponding conventional coronary artery catheterization, performed on following day, confirms nonsignificant stenotic lesions in left main and proximal left anterior descending coronary arteries (dotted arrows) and 62% diameter stenosis in mid left anterior descending coronary artery (solid arrow).

 


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  		Fig. 3A —45-year-old man with anterior wall myocardial infarction. Volume-rendered CT angiogram shows stenotic lesion in mid left anterior descending coronary artery (arrow).

 


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  		Fig. 3B —45-year-old man with anterior wall myocardial infarction. Corresponding curved planar reformations in two orthogonal projections (B) and global view of coronary vessel tree (C) show single soft plaque (solid black arrow) in mid left anterior descending (LAD) coronary artery that is causing 70% diameter stenosis. LMCA = left main coronary artery, CRX = circumflex coronary, RCA = right coronary artery.

 


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  		Fig. 3C —45-year-old man with anterior wall myocardial infarction. Corresponding curved planar reformations in two orthogonal projections (B) and global view of coronary vessel tree (C) show single soft plaque (solid black arrow) in mid left anterior descending (LAD) coronary artery that is causing 70% diameter stenosis. LMCA = left main coronary artery, CRX = circumflex coronary, RCA = right coronary artery.

 


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  		Fig. 3D —45-year-old man with anterior wall myocardial infarction. Corresponding conventional coronary catheterization, performed 5 days later, confirms 80% diameter stenosis (arrow) in mid left anterior descending coronary artery.

 


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  		Fig. 4A —57-year-old man 2 days after percutaneous transluminal coronary angioplasty and stent placement in proximal left anterior descending artery. Volume-rendered CT angiogram shows stent in proximal left anterior descending artery (thick black arrow). Note protrusion of proximal end of stent (dotted white arrow) into proximal left circumflex artery (thin black arrow). Also note left main coronary artery (solid white arrow).

 


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  		Fig. 4B —57-year-old man 2 days after percutaneous transluminal coronary angioplasty and stent placement in proximal left anterior descending artery. Corresponding curved planar reformation (B) and conventional coronary catheterization (C) show patent stent lumen (solid arrows). Proximal left circumflex artery has significant stenosis (dotted arrows) caused by protrusion of proximal end of stent.

 


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  		Fig. 4C —57-year-old man 2 days after percutaneous transluminal coronary angioplasty and stent placement in proximal left anterior descending artery. Corresponding curved planar reformation (B) and conventional coronary catheterization (C) show patent stent lumen (solid arrows). Proximal left circumflex artery has significant stenosis (dotted arrows) caused by protrusion of proximal end of stent.

 


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  		Fig. 5A —74-year-old man 2 years after percutaneous transluminal coronary angioplasty and stent placement in proximal left anterior descending artery. Curved planar reformation shows hypodense filling defects in both ends of stent (solid arrows) and faint visualization of patent stent lumen (dotted arrow).

 


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  		Fig. 5B —74-year-old man 2 years after percutaneous transluminal coronary angioplasty and stent placement in proximal left anterior descending artery. Corresponding conventional coronary catheterization shows string-like, significantly narrowed residual lumen (dotted arrow).

 

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