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Fig. 4 —Case example 1: 64-year-old man with history of hyperlipidemia and
atypical chest pain underwent electron beam tomography (EBT) coronary calcium
scanning and exercise myocardial perfusion SPECT on same day. Myocardial
perfusion SPECT showed large reversible anterior apical-septal defect
indicating presence of hemodynamically significant lesion in proximal left
anterior descending (LAD) artery. He was admitted immediately for coronary
angiography. EBT scans showed minimal LAD artery calcification in next
inferior slice than displayed in image a. Coronary calcium score was 8. EBT
scans were, however, suspected of showing large hypodense plaque in proximal
LAD artery. Subsequent quantitative analysis of lipid-rich plaque revealed
lipid-laden plaque (red on EBT scans; arrow on coronary
angiography and intravascular sonography images) in LAD artery beginning at
origin of large first diagonal branch (images a and b) and extending for
approximately 2 cm (image c). Images a and b are axial EBT views distal to
origin of first diagonal artery. Image c is vertical long-axis view showing
fused EBT and stress perfusion SPECT. Coronary angiography (image d) shows 80%
stenosis (arrow) of proximal LAD artery at and distal to origin of
first diagonal branch. Intravascular sonography confirmed presence of large
plaque burden (images e and f) and 80% stenosis in proximal LAD artery. In
image f, plaque on intravascular sonography is outlined in yellow and
lipid-rich plaque is shown with arrow. Patient underwent stenting after
intravascular sonography. QUANT = Plaquant.
