Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography
Matthew J. Budoff, MD*,*,
Stephan Achenbach, MD and
Andre Duerinckx, MD
* Division of Cardiology, Saint John's Cardiovascular Research Center, Harbor–UCLA Medical Center Research and Education Institute, Torrance, California, USA
Department of Internal Medicine II, University of Erlangen-Nuremberg, Erlangen, Germany
Division of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Figure 1 Electron-beam angiogram (left) and corresponding invasive angiograms (right) of a person referred to the cardiac catheterization laboratory for evaluation of chest pain. The three-dimensional reconstruction and corresponding angiograms revealed no significant obstructive disease, but did reveal 20% to 30% stenosis of right coronary artery in the midvessel (black arrow).
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Figure 2 Electron-beam angiogram of the distal coronary arteries. Although the distal right coronary can only be visualized 80% of the time by this technique, this image demonstrates the posterolateral marginal branch (PLMB) and posterior descending arteries (PDA). Image courtesy of Dr. Beh, Kuala Lumpur, Malaysia.
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Figure 3 Electron-beam angiogram taken after symptoms of chest discomfort status postpercutaneous coronary angioplasty of the proximal left anterior descending. The image reveals a restenosis (black arrows) of the left anterior artery on both noninvasive and invasive angiograms.
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Figure 4 Electron-beam angiogram of a person eight years' postcoronary bypass surgery. The left internal mammary graft is widely patent, inserting into the left anterior descending artery (black triangles). The distal artery is well seen and patent, with minimal distal disease. There are two closed saphenous vein grafts (black arrowheads), in addition to two patent saphenous vein grafts, one to a diagonal and one to an obtuse marginal. The right coronary artery has a 100% midvessel stenosis (black arrows).
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Figure 5 Electron-beam angiogram of a person 22 years after coronary bypass surgery. A saphenous vein graft is widely patent, inserting into the left anterior descending artery, just after a high-grade stenosis in the native coronary (white triangles). The distal artery is well seen and patent, extending around the apex of the heart. Three saphenous vein grafts are closed proximally (black arrowheads).
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Figure 6 Multislice computed tomography angiogram (four-detector) of the left anterior descending (L) and right coronary artery (R).
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Figure 7 Navigator-echo–based, noncontrast-enhanced magnetic resonance coronary angiography (A) in a patient with a stenosis of the left anterior descending coronary artery (arrows). (B) Corresponding invasive coronary angiogram of that patient.
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Figure 8 Three-dimensional surface reconstruction of normal coronary arteries obtained by navigator-echo–based three-dimensional magnetic resonance coronary angiography.
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Figure 9 Magnetic resonance coronary angiogram of the right coronary artery obtained in a single breath-hold. A stenosis of the right coronary artery can be seen (arrow, A). (B) Corresponding invasive coronary angiogram also demonstrates the stenosis.
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