ABSTRACT
While coronary imaging has been performed with electron beam computed technology (EBCT) and four-detector multi-detector computed tomography (MDCT), routine clinical use increased with 16-detector and subsequent scanner generation. 164–167 Based on the cumulative experience, MDCT imaging with modern CT systems allows comprehensive assessment of coronary anatomy (Figures 8.1–8.5). 168 Non-contrast-enhanced scans (CT calcium scoring) in certain asymptomatic patient populations allow an assessment of calcified plaque burden. 169 Indications for contrast-enhanced protocols (CT angiography (CTA)) in symptomatic patients include the evaluation of suspected obstructive coronary artery disease (CAD), bypass graft disease, and certain coronary stents. CTA is also applied to the assessment of non-atherosclerotic CAD, such as coronary anomalies, coronary muscle bridge, and coronary aneurysm. 34 142 143 144 Normal coronary anatomy https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429186318/82d84425-00cf-4291-bf75-b4e9afc9ca9b/content/fig8_1.jpg"/> Volume-rendered image of the heart with the left anterior descending and left circumflex (LCX) coronary arteries emerging under the left atrial appendage and left main (LM) origin (left upper panel). MPR images of the distal LM and proximal LAD and LCX (right panels). The great cardiac vein, which is faintly enhanced, is seen crossing over the LAD and LCX (left panel). Normal coronary anatomy https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429186318/82d84425-00cf-4291-bf75-b4e9afc9ca9b/content/fig8_2.jpg"/> This figure shows an enlarged image of the left main coronary artery. The VRI in the left panel shows the origin of the LM of the aorta. The MPR image on the right shows the proximal LM segment. There is no luminal stenosis or plaque accumulation. Normal coronary anatomy https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429186318/82d84425-00cf-4291-bf75-b4e9afc9ca9b/content/fig8_3.jpg"/> The VRIs in this figure show the course of the right coronary artery (RCA). The distal branch, the posterior descending coronary artery, at the inferior surface of the heart is shown. The coronary sinus is also visible and must be differentiated from the arterial system. Normal coronary anatomy https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429186318/82d84425-00cf-4291-bf75-b4e9afc9ca9b/content/fig8_4.jpg"/> The VRI in the center shows the course of the arteries and side branches. The small images show curved MPR images of the right coronary artery (left lower panel), left circumflex coronary artery (right lower panel), and left anterior descending coronary artery (right upper panel). There is no evidence of luminal stenosis or atherosclerotic plaque accumulation. (Videos 8.4-i, 8.4-ii, 8.4-iii) VRI, virtual angiographic images https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429186318/82d84425-00cf-4291-bf75-b4e9afc9ca9b/content/fig8_5.jpg"/> Volume-rendered images allow visualization of the course of the coronary arteries in relation to the underlying cardiac chambers corresponding to the angiographic planes. These images allow initial orientation and can also be visualized in virtual angiographic appearance as shown in this figure.
