INDICATION:
The patient is a 48 year old man with coronary risk factors including
tobacco use and family history of CAD admitted with chest pain.
Coronary CT angiography is requested for risk stratification and
assessment of coronary anatomy.
TECHNIQUE:
The patient’s resting heart rate was in the 60s BPM after treatment
with 5 mg of intravenous metoprolol and two 400 mcg doses of sublingual
nitroglycerin. Images were acquired with the Siemens dual-source 64-
slice CT scanner at 120 kV and 0.6 mm thick images were reconstructed
at 10% intervals throughout the cardiac cycle RR interval. A total of
80 mL of intravenous contrast was used. The 65% reconstruction
provided the best images of the coronary arteries. Left ventricular
systolic and aortic valve functions were analyzed by reconstructing the
heart and valve in 10% phases.
Dose modulation was/was not used.
FINDINGS:
The overall technical quality of the study is adequate.
The left main coronary artery (LM) branches into the left anterior
descending (LAD) and left circumflex (LCX) systems, separated by a
ramus intermedius (RI) branch. The right coronary artery (RCA) is the
dominant artery that gives off the posterior descending artery (PDA).
The LM has no apparent calcified or non-calcified plaques.
The LAD gives off two moderate-sized diagonal arteries and continues to
the apex. There are no apparent calcified or non-calcified plaques in
the adequately imaged portions of the LAD or its diagonal branches.
The RI is small and has no apparent calcified or non-calcified plaques
in the adequately imaged portions of the artery.
The LCX gives off two moderate-sized obtuse marginal branches and
continues as a small vessel in the AV groove. There are no apparent
calcified or non-calcified plaques in the adequately imaged portions of
the LCX or its obtuse marginal branches.
The RCA gives off an acute marginal artery and the PDA before
continuing as a moderate-sized posterolateral branch. There are no
apparent calcified or non-calcified plaques in the adequately imaged
portions of the RCA or its branches.
Qualitatively, the left ventricular (LV) systolic function is normal.
Quantitatively, the measured LV dimensions are normal:
LV end-diastolic volume = 101 mL
LV end-systolic volume = 46 mL
LV ejection fraction (EF) = 54%
LV end-diastolic wall thickness:
Basal anterior septum: 10 mm
Basal posterior: 9 mm
The left atrium, right ventricle, and right atrium are normal in size
and function. The aortic valve is trileaflet with normal excursion.
The imaged portions of the aorta, pulmonary arteries, and pulmonary
veins are normal in size with no significant abnormalities. There is
no pericardial effusion.
The esophagus is located to the left of the left atrium. Non-cardiac
findings were reviewed with Dr. Brian Hyslop.
CONCLUSIONS:
- No apparent flow-limiting coronary artery disease (see above)
- Right-dominant circulation
- Normal LV systolic function with a measured EF of 54%