Wall Motion Abnormalities Detection With Contrast-Enhanced Multislice Computed Tomography
A 63-year-old man with a previous history of myocardial infarction and primary angioplasty to the middle-left anterior descending artery presented with mild exertional angina. His risk factors were non–insulin-dependent diabetes mellitus, hypertension, and hyperlipidemia. Physical examination was unremarkable. A resting 12-lead ECG showed Q wave in the anterior leads. Multislice computed tomography angiography (MSCT) (Philips Medical System NV, Eindhoven, Holland) using 40 detectors demonstrated significant disease in left anterior descending and right coronary arteries. Contrast-enhanced images of the myocardium and left ventricle were compared with transthoracic echocardiography. MSCT images during the systolic phase were reconstructed retrospectively at 40% of the gated ECG. At 40% phase, the mitral valve was completely closed and the left ventricular contracted maximally. Mid-diastolic images were reconstructed at 75% of the gated ECG (Figures 1 through 4⇓⇓⇓). The images from MSCT correlated closely with those from echocardiography. In some segments, MSCT images were superior to those from echocardiography because of poor sonification windows in the latter. We recommend that patients be routinely screened for wall motion abnormalities during the systolic phase as part of MSCT coronary angiography analysis. It is easy and fast, does not require additional software, and presents no added risk.