Circulation. 2006;114:e519-e520
doi: 10.1161/CIRCULATIONAHA.106.624171
(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{at}heart-center.or.jp
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).
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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.
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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 (arrowhead), which probably represents contrast filling of an ulcerated cavity. The white arrow indicates the lumen.
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Figure 3. Baseline angiography showed severe narrowing of the distal segment of the right coronary artery (white arrow), without signs of dissection or ulcerated cavity.
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Figure 4. Plaque rupture (white arrow) can be clearly identified on optical coherence tomography images. Circumferential low signal intensity behind the rupture site is compatible with a cavity (denoted by the asterisk).
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This case illustrates the potential of 64-MSCT for detecting complex plaque morphology, thus allowing noninvasive plaque characterization.
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Acknowledgments
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Disclosures
None.
