What would be the CAD-RADS category for this case? (according to the new CAD-RADS 2.0)
CAD-RADS 3/P3/HRP
What is a high-risk plaque? (according to CAD-RADS 2.0)
A high-risk plaque is a coronary plaque with two or more high-risk features, being positive remodelling, spotty calcification, low-attenuation plaque (<30 HU) and "napkin ring sign". At least three high-risk features are present in this case: spotty calcification, low-attenuation plaque and positive remodelling.
What is a myocardial bridge?
A congenital coronary anomaly where a coronary artery takes a course through the myocardium.
Technique
patient premedication: beta blocker and nitrates
acquisition method: step and shoot (prospective acquisition)
contrast injection protocol: triphasic injection
Findings
normal coronary origins and proximal courses
right coronary dominance with a thin circumflex artery and a strong intermedius branch
Plaque burden:
calcium score (according to Agatson, not shown): 909
segment involvement score (SIS): 7 segments
Right coronary artery (RCA): gives rise to PDA and small PLB
small calcified plaques without relevant stenosis in the proximal and middle segments
plaque-related mild stenosis (25-49%) in the distal segment
no relevant plaques or stenoses in the posterior descending artery (PDA) and posterolateral branch (PLB)
Left main: short, strong
-
small calcified plaque, no stenosis
Left anterior descending artery (LAD): two diagonal branches
some calcified plaques without stenosis in the proximal segment
plaque-related moderate stenosis (~50%) with high-risk features in the middle segment as well as plaque-related mild stenosis in the first diagonal branch (D1)
myocardial bridge in the middle segment with no stenosis
distal segment and second diagonal branch with no plaques or stenoses
Ramus intermedius: strong lumen (~4 mm)
-
plaque-related moderate stenosis (50-69%) proximally
Circumflex artery (CX): (thin luminal diameter <2mm, one obtuse marginal branch)
proximal and distal segments with no plaque or stenoses
obtuse marginal branch with no plaque or stenoses
Other findings:
status post oesophagectomy with gastric pull-up
peribronchial thickening
Impression
moderate coronary stenosis of the ramus intermedius and in the middle segment of the LAD with a high-risk plaque as well as mild stenoses of the D1 and the distal RCA
severe overall plague burden
modifiers: high-risk plaque
Exam courtesy: Sven Winzler (radiographer)