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Coronary Artery Disease After Radiation Therapy for Hodgkin's Lymphoma: Coronary CT Angiography Findings and Calcium Scores in Nine Asymptomatic Patients

Jürgen Rademaker1, Heiko Schöder1, Nikki S. Ariaratnam2, Harry W. Strauss1, Joachim Yahalom3, Richard Steingart4 and Kevin C. Oeffinger5

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1270 York Ave., New York, NY 10021.
2 Department of Radiology, New York-Presbyterian Hospital, New York, NY.
3 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
4 Department of Cardiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
5 Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY.


Figure 1
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  		Fig. 1A —39-year-old man who had 45 Gy administered at radiation therapy 25 years ago. Curved reconstruction shows two areas of severe stenosis (straight arrows) in left anterior descending coronary artery (LAD) and multiple calcified plaques (arrowhead). More distal LAD has relatively wide diameter and might represent normal vessel or region of ectasia (curved arrow).

 

Figure 2
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  		Fig. 1B —39-year-old man who had 45 Gy administered at radiation therapy 25 years ago. Curved reconstruction shows right coronary artery with soft plaques (arrowheads) and calcified plaque (arrow).

 

Figure 3
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  		Fig. 2A —36-year-old man who had 34 Gy administered at radiation therapy 16 years ago. Curved reconstruction shows patient now has calcification in proximal left anterior descending coronary artery (arrows).

 

Figure 4
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  		Fig. 2B —36-year-old man who had 34 Gy administered at radiation therapy 16 years ago. Magnified axial curved reconstruction at same location as A shows calcified plaque (arrowhead), soft plaque (arrows), and patent lumen (outlined by circle). There is approximately 40% stenosis (cross-sectional area reduction).

 

Figure 5
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  		Fig. 3 —60-year-old woman, to whom 40 Gy was administered at radiation therapy 35 years ago, with diffuse disease and calcifications in left anterior descending coronary artery (LAD) (arrow) extending into left circumflex artery. Artifact makes diffuse disease with calcifications appear more prominent in this 3D volume-rendered image. This diffuse disease in proximal LAD was overestimated with coronary CT angiography. Cardiac catheterization showed no stenosis in LAD but high-grade stenosis in left circumflex artery (not shown).

 

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