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)

Massive bilateral hilar and mediastinal lymphadenopathy.

No lung mass was detected.

Mild emphysema.

Heart rate: ~70 bpm at rest -> 90 bpm during stress perfusion after Adenosin 140 µg/kg/min

Image quality: mild to moderate respiratory artifacts, otherwise no limitations

Morphology and functional analysis (endo-volume):

• LV-EDVI: 75 mL/m²

• LV-ESVI: 38 mL/m²

• LV-SVI: 37 mL/m²

• LV-EF: 49%

• cardiac output: 5.8 L/min

• cardiac index: 2.6 L/min/m²

• LV-ED wall mas index (without papillary muscles): 67 g/cm

• septum and inferior wall thickness: 9 and 8 mm

Findings:

Mild hypokinesia in basal inferoseptal and inferior segments.

No evidence of focal myocardial edema on STIR.

Mildly elevated T1 mapping values in septal and inferior segments (z-score: 2-3).

Small subendocardial perfusion defect under Adenosin stress in inferoseptal and inferior midventricular segments not visible during rest.

No intracavitary thrombi.

Impression:

Cardiac MRI findings are consistent with mild myocardial ischemia in midventricular inferioseptal and inferior segments.

Norma viability of the myocardium. No signs of infarction or myocardial scar tissue.

Mildly elevated T1 mapping values possibly mild myocardial edema.

Exam courtesy: Jeanette Moses & Tobias Jahn (medical imaging technologists)