PMC3605584_01
Computed tomography coronary angiography (A and B) and invasive coronary angiography (C) images show stenoses in the left anterior descending, first diagonal, and left circumflex arteries.
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Stenoses were identified in left anterior descending (LAD), first diagonal, and left circumflex (LCX) arteries and confirmed by invasive coronary angiography (Fig. 1).
Short-axis views of the left ventricle during adenosine stress show hypo-enhancement in the territory of the left anterior descending artery (yellow arrows) and left circumflex artery (gray arrows).
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Stress imaging identified reversible defects in LAD and LCX territories (Fig. 2; Supplemental Video 1).
With the use of automated software (Vitrea fX 6.0; Vital Images, Minnetonka, MN, USA) the transmyocardial perfusion ratio for each of the 17 myocardial segments was calculated by dividing the subendocardial by the subepicardial attenuation density. Normal areas are shown in yellow/orange, and abnormal areas are highlighted in purple/blue. The transmyocardial perfusion ratio during adenosine stress is shown superimposed on short-axis views of the left ventricle. A color-coded bar on the left shows the range of transmyocardial perfusion ratios from black (0.5) to white (1.5).
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Transmyocardial perfusion ratio plots highlight these defects (Figs. 3 and 4; Supplemental Video 2).
Detailed bulls-eye plots of the transmyocaridal perfusion ratio of the left ventricle at rest (A) and during adenosine stress (B). Normal areas are shown in yellow/orange, and abnormal areas are highlighted in purple/blue. A color-coded bar on the right shows the range of transmyocardial perfusion ratios from black (0.5) to white (1.5).
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Transmyocardial perfusion ratio plots highlight these defects (Figs. 3 and 4; Supplemental Video 2).
Magnetic resonance myocardial perfusion imaging during adenosine stress. Short-axis views at 3 points over the left ventricle are shown with perfusion defects that correlate to the computed tomography images.
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Figure 5 shows correlative magnetic resonance perfusion images.
Delayed enhancement imaging from magnetic resonance imaging on the left and CT on the right. No areas of delayed enhancement were identified.
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Delayed enhancement was not identified on CT or magnetic resonance imaging (Fig. 6).