Akihiro Yoshimura

Regression of an atherosclerotic coronary artery plaque demonstrated by multislice spiral computed tomography in a patient with stable angina pectoris.

Multislice spiral computed tomography (MSCT) permits direct visualization of not only coronary artery stenosis but also atherosclerotic plaques in patients with coronary artery disease. In this report, we describe a patient with stable angina in whom the regression of the plaque was documented by serial MSCT examinations. In the patient, a 46-year-old man with stable angina, MSCT revealed a stenotic lesion at the proximal portion of the left anterior descending artery. Axial, curved multiplanar reconstruction and cross-sectional images consistently depicted a protruding computed tomography low-signal mass suggesting an atherosclerotic plaque. Intracoronary ultrasound (ICUS) also documented an eccentric soft plaque with an echo-lucent mass suggesting a lipid core. Lipid-lowering therapy with pravastatin was started. Follow-up MSCT performed 7 months later documented an increase in the luminal area while the external vessel area remained unchanged. The regression of the plaque was also confirmed by a follow-up ICUS study. MSCT was thought to be feasible for serial evaluation of the plaque size and texture.

Visualization of a coronary collateral channel by multislice spiral computed tomography

motion artifacts which occur during the rapid filling and atrial contraction periods, and allows for a better image quality as compared to the conventional technique which utilizes the R-R interval as a reference. The data were transferred to a computer workstation for post-processing (3D Virtuoso, Siemens, Germany). The scan was completed within 15min and post-processing, including manual reconstruction of volume rendering and curved multiplanar images, required 20min with the use of our image reconstruction method. Figure 1A demonstrates complete occlusion at the proximal portion of the RCA with retrograde contrast enhancement of the distal segments and the right ventricular branch. Figure 1B shows a volume-rendering image of the distal portions of the RCA and the LCx. A well-developed collateral channel connecting the distal portion of the LCx and the atrioventricular node branch of the RCA was visualized. A curved multiplanar reconstruction image also depicted a collateral channel (Fig. 1C). With its excellent spatial resolution, MSCT not only permits visualization of the major coronary artery segments, but also has the potential to detect well-developed collateral channels in patients with complete coronary artery occlusion when artifact-free images are obtained.