Coronary plaque evaluation

Benefits or pitfalls of dual-energy CT

Patient presented with sudden chest pain at night, sweating and chest congestion, and pain radiating to left upper limb. V1 - V5 ST segment elevation on ECG, diagnosed as acute ST-elevation myocardial infarction (Killip grade 1).

Virtual monoenergetic images at high keV are effective in reducing blooming artifacts from the mixed plaque and in more clearly displaying the stenosis of the coronary lumen. Virtual monoenergetic images at low keV and Z effective maps are useful for differentiating the plaque composition.

Key images

Findings

Axial images, curved plane reformatted (CPR) images

Multiple lesions were shown in the coronary arteries, including a mixed plaque at the proximal right coronary artery. Monoenergetic 90 keV images reduced the blooming artifact from calcifications and provided a better estimation of the lumen stenosis. Iodine no Water, monoenergetic 60 keV, monoenergetic 200 keV images, and Z effective maps demonstrated the plaque composition clearly.

Discussion

CCTA spectral imaging not only provides conventional coronary artery images but also reduces blooming artifacts from calcifications and helps in differentiating the composition of different types of plaques.

History

Benefits or pitfalls of dual-energy CT

Key images

Findings