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CT and MRI of Coronary Artery Disease:Evidence-Based Review

¹ Both authors: Division of Cardiothoracic Radiology, Department of Radiology, Taubman Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0326.

View larger version (95K): [in a new window]   Fig. 1A —CT coronary angiography in two patients with chest pain. 25-year-old woman with chest pain on exertion. Axial image from CT angiography shows left main coronary artery arising from right sinus of Valsalva, which has common origin with right coronary artery. Left coronary artery then passes between aorta and pulmonary outflow tract.

View larger version (80K): [in a new window]   Fig. 1B —CT coronary angiography in two patients with chest pain. 40-year-old man with atypical chest pain. Curved multiplanar reformatted image from CT angiography shows a myocardial bridge in left anterior descending artery.

View larger version (134K): [in a new window]   Fig. 2A —29-year-old man who presented to emergency department with acute onset of chest pain. Curved multiplanar reformatted image from CT angiography of right coronary artery shows multiple coronary artery aneurysms.

View larger version (144K): [in a new window]   Fig. 2B —29-year-old man who presented to emergency department with acute onset of chest pain. Curved multiplanar reformatted image of left main and left anterior descending coronary arteries shows left anterior descending coronary artery aneurysm.

View larger version (137K): [in a new window]   Fig. 3A —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Multiplanar reformations from CT angiography of right coronary artery curved (A) and straightened (B).

View larger version (56K): [in a new window]   Fig. 3B —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Multiplanar reformations from CT angiography of right coronary artery curved (A) and straightened (B).

View larger version (133K): [in a new window]   Fig. 3C —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Multiplanar reformatted images of left anterior descending artery (LAD) with vessel curved (C) and straightened (D). Note focal, eccentric, mixed calcified and soft plaque causing less than 25-30% stenosis of proximal vessel.

View larger version (64K): [in a new window]   Fig. 3D —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Multiplanar reformatted images of left anterior descending artery (LAD) with vessel curved (C) and straightened (D). Note focal, eccentric, mixed calcified and soft plaque causing less than 25-30% stenosis of proximal vessel.

View larger version (101K): [in a new window]   Fig. 3E —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Images show cross-sectional view of LAD at area of plaque (E), LAD with first and second diagonals (F), and left circumflex coronary artery and its marginal branch (G).

View larger version (97K): [in a new window]   Fig. 3F —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Images show cross-sectional view of LAD at area of plaque (E), LAD with first and second diagonals (F), and left circumflex coronary artery and its marginal branch (G).

View larger version (131K): [in a new window]   Fig. 3G —40-year-old man with hyperlipidemia, atypical chest pain, and family history of premature atherosclerotic heart disease. Images show cross-sectional view of LAD at area of plaque (E), LAD with first and second diagonals (F), and left circumflex coronary artery and its marginal branch (G).

View larger version (135K): [in a new window]   Fig. 4A —70-year-old man with paroxysmal ventricular tachycardia. Delayed contrast-enhanced short-axis MR image shows transmural enhancement of inferior wall of left ventricle that extends to inferior septum. Note thin inferior wall of left ventricle measuring less than 5 mm.

View larger version (151K): [in a new window]   Fig. 4B —70-year-old man with paroxysmal ventricular tachycardia. Delayed contrast-enhanced MR image in two-chamber long-axis view shows transmural enhancement of inferior left ventricular wall.

View larger version (170K): [in a new window]   Fig. 5A —68-year-old man with suspected coronary artery disease who presented with atypical chest pain and hyperlipidemia. (Courtesy of Gebker R, CMR Academy, German Heart Institute, Berlin, Germany) Basal short-axis images from adenosine stress perfusion MRI with patient at rest (A) and at stress (B) show two inducible subendocardial defects of basal anterior and lateral walls. See also Figure S5C, video of first-pass short-axis images (apical, mid, and basal) from stress perfusion MRI, in supplemental data online.

View larger version (163K): [in a new window]   Fig. 5B —68-year-old man with suspected coronary artery disease who presented with atypical chest pain and hyperlipidemia. (Courtesy of Gebker R, CMR Academy, German Heart Institute, Berlin, Germany) Basal short-axis images from adenosine stress perfusion MRI with patient at rest (A) and at stress (B) show two inducible subendocardial defects of basal anterior and lateral walls. See also Figure S5C, video of first-pass short-axis images (apical, mid, and basal) from stress perfusion MRI, in supplemental data online.

View larger version (99K): [in a new window]   Fig. 6A —CT angiography images in 60-year-old man with history of coronary artery disease and multiple bypass grafts who presented with occasional mild chest pain 3 years after bypass surgery. Three-dimensional volume-rendered image shows origin and course of left internal mammary graft to left anterior descending artery and saphenous vein graft to right coronary artery.

View larger version (175K): [in a new window]   Fig. 6B —CT angiography images in 60-year-old man with history of coronary artery disease and multiple bypass grafts who presented with occasional mild chest pain 3 years after bypass surgery. Curved multiplanar reformatted image of saphenous vein graft to right coronary artery shows graft is patent.

View larger version (133K): [in a new window]   Fig. 6C —CT angiography images in 60-year-old man with history of coronary artery disease and multiple bypass grafts who presented with occasional mild chest pain 3 years after bypass surgery. Curved multiplanar reformatted image shows left internal mammary artery graft to anterior descending artery is patent.

View larger version (151K): [in a new window]   Fig. 6D —CT angiography images in 60-year-old man with history of coronary artery disease and multiple bypass grafts who presented with occasional mild chest pain 3 years after bypass surgery. Multiplanar reformatted image in oblique sagittal plane shows surgical clips and stump of saphenous vein graft (arrow) arising from aorta. Graft could not be followed distally to its anastomosis with an obtuse marginal artery and is occluded.

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