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(Circulation. 2006;114:e519-e520.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sixty-Four–Multislice Computed Tomography Image of a Ruptured Coronary Plaque

Nobuyoshi Tanaka, MD; Mariko Ehara, MD; Jean-François Surmely, MD; Tetsuo Matsubara, MD; Mitsuyasu Terashima, MD; Etsuo Tsuchikane, MD; Osamu Katoh, MD; Takahiko Suzuki, MD

From Toyohashi Heart Center, Department of Cardiology, Toyohashi, Japan.

Correspondence to Nobuyoshi Tanaka, MD, Toyohashi Heart Center, 21-1 Gobudori, Oyama-cho, Toyohashi 441-8530, Japan. E-mail ntanaka@heart-center.or.jp

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Noninvasive investigation with 64-multislice computed tomography (MSCT) was performed in a 57-year-old patient with a history of diabetes mellitus and hypertension because of suspected ischemic heart disease. A severe short stenosis of the distal right coronary artery was visualized. A density parallel to the true lumen was observed at the region (Figure 1). On the cross-sectional image, the plaque appeared eccentric with a complex signal-density pattern: a low-density lesion, which is compatible with lipid-rich plaque, and a crescent moon–like isodensity region, which probably represents contrast filling (Figure 2). These findings were interpreted as contrast filling in an ulcerated cavity after plaque rupture. Elective invasive coronary angiography was performed. Baseline angiographic images confirmed the severe narrowing, but the ulcerated cavity was not seen (Figure 3). To further clarify the significance of those MSCT findings, we performed preintervention invasive imaging with optical coherence tomography. On the optical coherence tomography images, a ruptured plaque was clearly identified, and the circumferential low signal intensity behind the rupture site was compatible with an ulcerated cavity (Figure 4).

View larger version (56K): [in this window] [in a new window]   Figure 1. A 64-MSCT image showing a severe stenosis of the distal right coronary artery (white arrow). A density parallel to the true lumen can be seen (arrowhead), which could represent a spontaneous coronary dissection with an ulcerated cavity.

View larger version (80K): [in this window] [in a new window]   Figure 2. Cross-sectional 64-MSCT image showing an eccentric plaque with a complex signal-density pattern: a low-density region (yellow arrow), which is compatible with lipid-rich plaque, and a crescent moon–like isodensity region . . . [Full Text of this Article]