Technique
patient premedication: beta blocker and nitrates
acquisition method: step and shoot (prospective acquisition)
contrast injection protocol: triphasic injection
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image reconstruction:
standard iterative reconstruction with edge correction
dual-energy maps (see next study)
Findings
anomalous origin of the circumflex artery from right coronary sinus with a retroaortic course
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right coronary arterial dominance:
circumflex artery from right coronary sinus
large posterior descending artery (PDA and right posterolateral branch (RPLB)
Plaque burden:
coronary calcium score: ~400
segment involvement score (SIS): 7 segments
Right coronary artery (RCA):
gives off a double posterior descending artery (PDA) and a posterolateral branch (RPLB)
multiple calcified plaques in the proximal and middle segments with no or minimal stenosis
no plaques or stenoses in the distal segment, PDA and RPLB
Circumflex artery (CX): two obtuse marginal branches and left posterolateral branch
several non-stenotic calcified plaques in the proximal segment
long mixed plaque with moderate stenosis (D: ~50-69%; area: ~70%) of the OM2
no plaques or stenoses in the thin OM1 and posterolateral branch
Left anterior descending artery (LAD): two strong diagonal branches (D1 & D2)
mixed plaque with mild stenosis (25-49%) in the proximal segment
myocardial bridge in the distal segment (length: ~15 mm; depth: ~2 mm)
Aortic valve:
calcified
small diastolic aortic regurgitant orifice area ~3 mm² at 73-83% of the RR interval
Impression
anomalous origin of the circumflex artery from right coronary sinus with two adjacent ostia and a retroaortic course
heavy amount of plaque - CAC-DRS A3/N3 and V3/N3
mild non-obstructive coronary artery disease - CAD-RADS 3/P3/E
small myocardial bridge of the left anterior descending artery
aortic valve calcification with mild aortic insufficiency possibly mixed valve disease
Exam courtesy: Yvonne Kühn (radiographer)