1Institute of Diagnostic Radiology; 2Clinic of Cardiovascular Surgery, 3Cardiology Division, University Hospital, Zürich; 2Radiology Department, Innsbruck Medical University; 4Business Unit CT, Siemens Healthcare, Forchheim, Germany.
A 51-year-old male with atypical chest pain and intermediate coronary risk profile (cigarette smoking and hypercholesterolemia) underwent coronary 128-slice Dual Source CT angiography, including adenosine myocardial stress-perfusion.
High-pitch CT angiography showed severely calcified left coronary artery (Fig. 1) with significant stenosis, and bare metal stent in the RCA (Fig. 2) with limited in-stent lumen visibility, thus in-stent restenosis could not be excluded.
Adenosine CT stress perfusion showed a reversible myocardial perfusion defect indicating ischemia anteroseptal at midventricular level (Fig. 3) corresponding to LAD stenosis. No defect was found inferior at RCA vascular territory. Invasive angiography confirmed a significant 90% stenosis at mid LAD and a patent RCA bare-metal stent.
Total radiation dose was 2.2 mSv for adenosine stress and rest CT scans using high-pitch Flash mode at 3.4 pitch factor, the delay between both scans was 5 minutes. Scan time was 0.44 s for each study, tube settings were 100kV and 320 mAs, gantry rotation time was 0.28 s.
Adenosine stress-perfusion is feasible for detection of reversible myocardial ischemia with comprehensive evaluation of coronary arteries. CT perfusion is helpful to improve accuracy of coronary CT angiography, especially in cases of severe coronary calcification or limited in-stent lumen visibility.
The information presented in this case study is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard.
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.