Dual Source CT unveils several high-grade stenoses of coronary arteries

SOMATOM Definition Dual Energy Scanning

Dr. Evgeny Egin
Department of Cardio Center Volgograd, Russia
 |  20-03-2009

History

A 77-year-old male patient presented with chest pain.at the Radiology department of the Cardio Center Volgograd, Russia in preparation for aortic femoral bypass surgery
The patient had a known history of several atherosclerotic arteries without hemodynamic relevant stenoses and atrial fibrillation.
The patient also suffered from chronic iron-deficiency, cerebral atherosclerosis with temperate Parkinson-Syndrome and intervertebral osteochondrosis with neurovascular disorders.

 

Diagnosis

Prior to the contrast enhanced scan, a calcium scoring native cardiac scan was performed. Almost every segment showed coronary artery calcifications.
The coronary CTA was performed with an arrhythmic heart rate of 65 – 181 bpm, on average 94 bpm.
Aorta and pulmonary artery trunk and branches were not dilated.
The scan revealed a right dominant heart, wide left main coronary artery (LM), left circumflex artery (CX) and its marginal branch as well as the right ventricular branch, all without hemodynamic relevant stenoses.
A high-grade stenosis was detected in first diagonal branch (D1), approximately 8 mm from the ostium.
Significant calcified plaques in the proximal part of the right coronary artery (RCA) and the left coronary artery descending (LAD) causing high-grade stenoses with hemodynamic relevance were observed. Another high-grade stenosis was found in D1.

 

Comments

With the high temporal resolution of the Dual Source CT, it was possible to perform a reliable and quick diagnosis even with this extreme arrhythmic heart rate.

Examination Sequence Protocol

Scanner SOMATOM Definition
Scan area Cardiac
Scan length 179mm
Scan time 13s
Scan direction cranio-caudal
Heart-rate 65-181bpm, 94 avrg.
Tube-voltage 120kV/120kV
Tube-current 198 mAs/rot
Rotation time 0.33s
Temporal resolution 83ms
Slice collimation 0.6mm
Slice-width 0.75mm
Reconstruction-increment 0.7mm
Reconstruction-kernel B26f

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The drugs and doses mentioned herein are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the CT System. The source for the technical data is the corresponding data sheets. Results may vary.