Presentation
On ergometry not quite significant ST-segment depression in II, III, aVF, and V4-6.
Patient Data
Technique
patient premedication: beta blockers and nitrates
acquisition method: step and shoot (prospective acquisition)
contrast injection protocol: triphasic injection
standard image reconstruction
Findings
normal coronary origins and proximal courses
right or balanced coronary arterial dominance
Plaque burden:
-
calcium score: no calcifications
Right coronary artery (RCA): gives rise to a double posterior descending artery
no plaques or stenoses in the proximal, middle, and distal segments
posterior descending artery (PDA): no plaques or stenosis
Left main (LM): short, otherwise inconspicuous
Left anterior descending artery (LAD): one small diagonal branch
no plaques or stenoses in the proximal, middle, and distal segments
no plaques or stenoses of the diagonal branch (D1)
Circumflex artery (CX): obtuse marginal branch, two left posterolateral branches
no plaques or stenoses in the main epicardial vessel
no plaques or stenosis of the obtuse marginal (OM) and posterolateral branches
Impression
normal coronary CT angiogram
no evidence of coronary stenosis or plaques - CAD-RADS 0
old spinal compression fractures
Exam courtesy: Yvonne Kirchner-Bock (radiographer)
MonoE 40 and 55 keV
virtual monoenergetic images, synthesized at a level of 40 keV and 55 keV, respectively
reconstructions in a soft tissue algorithm with a window setting of C:800 W:2000
Conventional + MonoE 40 overlay
-
conventional images, reconstructed with a standard soft tissue filter and supplemented with a color-coded MonoE 40 overlay ranging from -600 to 1400 (C:400 W:2000)
Iodine, no water + virtual non-contrast overlay
iodine no water images obtained by subtracting water from contrast-enhanced images with a color-coded virtual non-contrast overlay (VNC) ranging from -200 to 400 (C:100 W:600)
this setting can be nicely used to illustrate calcium (no coronary calcifications in this study)
Z-effective
-
the effective atomic number Zeff calculated by dual-energy analysis
Case Discussion
A case of a normal coronary CTA with different dual-energy maps for viewing.
The absence of any luminal stenosis or plaques is consistent with a CAD-RADS 0 category. The patient was reassured and requires no further investigation for coronary artery disease 1.
This case also shows an interesting coronary variation, with the circumflex artery supplying a large part of the left ventricle via strong marginal and posterolateral branches, as well as a double posterior descending artery originating from the right coronary artery 2.
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