What would be an option to get rid of motion artifacts in a sequential cardiac scan (step and shoot) at the level of the transition of the sequential acquisition steps?
Image reconstruction without edge correction.
What is the disadvantage of image reconstruction without edge correction?
The sharp edge between the sequential acquisition steps is clearly visible and stair step artifacts due to breathing will be visible on multiplanar coronary and sagittal as well as on 3D reconstructions.
Technique
patient premedication: beta blocker and nitrates
acquisition method: step and shoot (prospective acquisition)
contrast injection protocol: triphasic injection
image reconstruction with edge correction
Findings
normal coronary origins and proximal courses
right coronary dominance strong double intermedius branch
corkscrew-like tortuous terminal vessels
Plaque burden:
calcium score (according to Agatson, not shown): 1601
segment involvement score (SIS): 10 segments
Right coronary artery (RCA): gives rise to PDA and RPLB
multiple calcified plaques and severe calcifications in the distal segment
low-grade stenosis (25-49%) in the proximal segment by an odd-looking plaque versus artifact in the transition zone of the cranial and middle sequential axial scan rotations
calcified hardly assessable stenosis in the middle segment and moderate stenosis (50-69%) in the distal segment
no relevant plaques or stenoses in the posterior descending artery (PDA) and posterolateral branch (RPLB)
Left main: quadrifurcation with a strong and a thin ramus intermedius branch
-
no plaques or stenosis
Left anterior descending artery (LAD): one diagonal branch
multiple calcified plaques
plaque-related moderate stenosis in the proximal segment (50-69 %)
small diagonal branch with a thin lumen and no relevant plaques or stenoses
Ramus intermedius: duplicate with a thin proximal and strong branching distal branch
-
plaque-related moderate stenosis (50-69%) proximally at the origin of the dominant branch
Circumflex artery (CX): two obtuse marginal branches
multiple calcified plaques
low-grade plaque-related stenoses (25-49%) in the proximal and distal thirds
obtuse marginal branches with no plaque or stenoses
Impression
moderate coronary stenoses (50-69%) in the proximal LAD and the origin of the dominant ramus intermedius branch and questionable further significant stenosis in the distal part of the RCA
extensive overall plague burden
quadrifurcation of the left main with duplicate ramus intermedius artery
corkscrew-like tortuous terminal vessels indicating hypertensive disease
Exam courtesy: Yvonne Kühn (radiographer)