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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2007; 34(3): 388–389.
PMCID: PMC1995048

Can Multidetector CT Angiography Detect Coronary Artery Dissection?

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute and St. Luke's Episcopal Hospital, 6624 Fannin Street, Suite 2480, Houston, TX 77030

A patient presented with exertional angina that was not responding to maxi-mal medical therapy. Five years earlier, he had undergone coronary angio-plasty in treatment of an inferior myocardial infarction. No documentation of this coronary intervention was available.

Multidetector computed tomographic (MDCT) angiography (Philips Brilliance CT 40-Slice, Philips Medical Systems; Best, The Netherlands) of the coronary arteries in this patient showed dissection of the right coronary artery (Fig. 1). After considering the MDCT images, we performed conventional coronary angiography. The left coronary artery appeared normal on both MDCT and coronary angiography. Dissection of the right coronary artery was confirmed by coronary angiography (Fig. 2), which technique appeared to indicate that the dissection was an old event; we deemed it a catheter-induced coronary dissection. The distal extent of the dissection was not clear on MDCT angiography when the images were analyzed retro-spectively. As a result, we consider the quality of the coronary angiographic images to be superior to that of their MDCT angiographic counterparts in the evaluation of this case of coronary dissection.

figure 25FF1
Fig. 1 Multidetector computed tomographic angiography reveals the dissection of the proximal segment of the right coronary artery (RCA) (arrows).
figure 25FF2
Fig. 2 Coronary angiography shows the dissection of the right coronary artery (arrows) at the proximal and middle segments. The dissection was probably old and consequent to the coronary catheterization of 5 years before. The stenosis of the posterolateral ...

Comment

Multidetector computed tomographic angiography is a noninvasive diagnostic cardiac imaging method, useful in particular for inspecting the coronary arteries.1 It helps physicians to diagnose coronary artery disease and to see coronary artery aneurysms that have resulted from Kawasaki disease.2,3 To date, it has not been clear that MDCT angiography could detect coronary artery dissection.

We believe that MDCT angiography is a promising cardiac imaging method that can detect coronary artery dissection, in addition to usual diagnostic indications. How-ever, as demonstrated by the present case, a diagnosis of dissection on MDCT should be confirmed by use of coronary angiography.

Footnotes

Address for reprints: Mutlu Vural, MD, Bayar cad. Pinar sok. Catalpinar sitesi B blok 8/27, 34742 Kozyatagi, Kadikoy, Istanbul, Turkey. E-mail: moc.oohay@plakippeh

References

1. Manghat NE, Morgan-Hughes GJ, Marshall AJ, Roobottom CA. Multi-detector row computed tomography: imaging the coronary arteries. Clin Radiol 2005;60:939–52. [PubMed]
2. Ghersin E, Litmanovich D, Dragu R, Rispler S, Lessick J, Ofer A, et al. 16-MDCT coronary angiography versus invasive coronary angiography in acute chest pain syndrome: a blinded prospective study. AJR Am J Roentgenol 2006;186:177–84. [PubMed]
3. Sohn S, Kim HS, Lee SW. Multidetector row computed tomography for follow-up of patients with coronary artery aneurysms due to Kawasaki disease. Pediatr Cardiol 2004;25: 35–9. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute