Heavily calcified coronary arteries

Discussion

70-year-old male with history of atypical chest pain.

Spectral Iodine no Water images enabled better assessment of coronary artery lumen in a patient with heavily calcified coronary arteries.

Axial images, curved multiplanar reformation (MPR)

Conventional image shows heavily calcified proximal left anterior descending coronary artery (LAD). The lumen is essentially nonevaluable rendering the study non-diagnostic. Spectral Iodine no Water source image and stretched MPR depicts the vascular lumen selectively and is capable of removing most of the vascular wall calcium. The lumen can now be evaluated, showing that the origin of the left main coronary is narrowed, whereas the distal left main and LAD appear to be patent without significant stenosis.

Spectral CT allows for reduction of the impact of coronary vascular wall calcium on evaluation of the presence and degree of coronary artery stenosis. In addition, reconstructions can be created that allow for quantitative evaluation of iodine uptake in the myocardium.

Conventional CT image: Shows heavy calcifications in the proximal LAD (red arrow), which makes evaluation of this vessel impossible.

Spectral Iodine no Water image: Shows greatly reduced calcium burden, which makes the LAD evaluable. There is a significant stenosis at the ostium of the left main coronary artery (red arrow). Further distally, there are no significant lesions in the proximal LAD.

History