CT - Cardiac CTA
Axial non-contrast
Axial C+ arterial phase
Short axis C+ arterial phase
VLA C+ arterial phase
Curved RCA
Curved LAD
Curved CX
Curved OM1
3D Heart
3D Coronaries
What would be the CAD-RADS category for this case - according to CAD-RADS 2.0?
CAD-RADS 5/P2
What would you do and recommend based on the cardiac CT findings?
Invasive coronary angiography and viability assessment should be considered. The patient should receive aggressive risk factor modification and optimal medical therapy. Other cardiovascular treatment options such as anti-anginal therapy and revascularisation should be considered as per guidelines. The mediastinal and hilar lymphadenopathy should be investigated further.
Technique
patient premedication: beta blocker and nitrates
acquisition method: step and shoot (prospective acquisition - 100 KV)
contrast injection protocol: triphasic injection
image reconstruction: standard without edge correction
Findings
normal coronary origins
balanced coronary arterial dominance
long occluded segment of the right coronary artery
massive bilateral hilar and mediastinal lymphadenopathy
Plaque burden:
calcium score (according to Agatson, not shown): 104
segment involvement score: 3-4
Right coronary artery (RCA): double distal segment
high-grade stenosis in the proximal segment with subsequent segmental occlusion of the distal proximal and middle segments
the doubled distal segment is being fed via collaterals
Left main: inconspicuous
Left anterior descending artery (LAD): two diagonal branches
eccentric mixed plaque in the proximal segment without significant stenosis
thin, rudimentary first diagonal branch
strong second diagonal branch without stenosis
stair step artifact in the distal segment
Circumflex artery (CX): two marginal branches (OM1 & OM2) and posterolateral branch
eccentric calcified plaque of the proximal segment
thin first marginal branch with at least moderate stenosis proximally (D: 50-69%)
no plaques or stenosis of the second marginal and posterolateral branches
stair step artifact in the distal segment
Impression
chronic occlusion of the right coronary with distal collateralisation
proximal moderate stenosis of a thin first marginal branch
moderate amount of coronary plaque
CAD-RADS 5/P2
massive bilateral hilar and mediastinal lymphadenopathy
Exam courtesy: Silva Reinecke (medical imaging technologist)