References

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2. Herzog C, Britten M, Balzer JO, Mack MG, Zangos S, Ackermann H, Schaechinger V, Schaller S, Flohr T, Vogl TJ . Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atypical, chest pain. Eur Radiol 2004;14(2):169-77.


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Figure 1: Normal nuclear medicine rubidium PET perfusion study. Images for each region of the heart are arranged in rows of 2, with stress images on top and rest images on the bottom. Compare row 1 to row 2, row 3 to row 4, and so forth. The cardiac tracer activity is depicted by the bright color. Note how the appearance of the color for the comparable rows is similar - this indicated relatively similar perfusion during rest and stress. Compare with abnormal scan in Figure 2.

Figure 2: Abnormal nuclear medicine rubidium PET study. Images for each region of the heart are arranged in rows of 2, with stress images on top and rest images on the bottom. Compare row 1 to row 2, row 3 to row 4, and so forth. The cardiac tracer activity is depicted by the bright color. Note the differences between comparable rows. For example, the very top row shows stress images in the short axis projection. Compare these to the short axis rest views immediately below. Note how bright color is absent on the bottom portions of the stress images, creating an incomplete circle, but that this color returns and forms a complete circle on the rest images - this pattern indicates reversible ischemia and is indicative of CAD in the artery supplying the bottom portion of the heart.

Figure 3: Coronary calcium scanning with CT.
Image shows calcium within the left anterior descending coronary artery. The calcium appears as bright, white foci along the course of the artery.
The same image shows the calcium has been detected by the computer program and is labeled in red during the calcium scoring process.

Figure 4: Coronary CT Angiography. CT image shows the entire course of the right coronary artery. The vessel shows no evidence of CAD.

Figure 5: Non-calcified plaque in a patient with a coronary calcium score of 0.
A. Coronary CTA image shows non-calcified plaque in the first portion of the left anterior descending coronary artery. The coronary artery itself is not severely narrowed by this plaque.
B. Coronary CTA image labeled to show plaque (outlined in yellow).

Figure 6: Whole-heart coronary CTA. This model of the heart and coronary arteries was created from a normal 64-slice coronary CTA examination. The image initially shows a normal left main and left anterior descending coronary artery. The image rotates towards the right, revealing a normal, dominant right coronary artery that continues along the undersurface of the heart as the posterior descending coronary artery. Finally, the model continues to rotate, ending at a normal left circumflex coronary artery.

Figure 7: MRI / MRA image obtained in a patient suspected to have an anomalous coronary artery course. MR image shows a normal left anterior descending coronary artery.

Figure 8: MRI / MRA image in a 10-year-old boy with Kawasaki disease (a disease that may create dilation - or aneurysms - of the coronary arteries. MR image shows hugely dilated coronary arteries.

Figure 9: MRI / MRA image in a patient with MI undergoing viability imaging. The image shows intense delayed enhancement, representing areas of non-viable heart.

Figure 10: Selective contrast ("dye") injection into the left main coronary artery shows opacification of the two primary branches of the left main coronary artery: the left anterior descending coronary artery and the left circumflex coronary artery. The catheter, or tube, through which contrast is injected is visible (arrow).

Figure 11: Selective contrast ("dye") injection into a normal right coronary artery. The catheter through which contrast is injected is again visible (arrows).

Figure 12: Severe atherosclerotic disease of one of the primary coronary arteries.

Figure 12A.Image obtained during catheter coronary artery angiography shows severe narrowing (stenosis) of the left anterior descending artery (arrow)

Figure 12B. Second image shows inflation of a balloon ("angioplasty") in the area of stenosis.

Figure 12C. Final image shows that the stenotic vessel has retuned to normal caliber. A stent (metal device used to maintain the caliber of the vessel) was subsequently placed in the abnormal region.