Multislice Computed Tomography and Magnetic Resonance Imaging
Complementary Use in Noninvasive Coronary Angiography
A 68-year-old woman with a relevant cardiovascular risk profile presented with atypical chest pain. Ergometric exercise demonstrated an insignificant ST-segment deviation in the precordial leads and premature beats increasing in frequency during exercise.
Calcium scoring by multislice computed tomography (MSCT; Sensation Cardiac) revealed a very high calcium volume score of 3639 mm3, a mass score of 1005.88 mg calcium hydroxyapatite, and an Agatston score equivalent1 of 4648.9. Because of this severe coronary calcification, subsequent contrast-enhanced, MSCT-based angiography failed to demonstrate the coronary lumina and to detect significant stenosis of the right coronary artery (Figure 1). Not being sensitive for but “filtering” calcification, magnetic resonance imaging (MRI)–based coronary angiography (1.5 T; balanced turbo field echo) detected a high-grade stenosis of the mid right coronary artery (Figure 2), which was confirmed by invasive coronary angiography as the reference standard (Figure 3).
Contrast-enhanced MSCT is an established technique in noninvasive coronary angiography.2 However, detection of significant coronary stenoses can be limited by marked calcification.1 As reported here, there are cases in which MRI-based coronary angiography is superior to CT by excluding calcification. In noninvasive coronary angiography, MSCT and MRI may be used complementarily.
Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, Claussen CD, Kopp AF, Schroeder S. Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. J Am Coll Cardiol. 2005; 45: 123–127.
Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, Schlundt C, Bautz W, Daniel WG, Achenbach S. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation. 2003; 107: 664–666.