The Potential Role of Cardiac CT in Patients with Acute Coronary Syndrome

Figures

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  Fig. 1. Myocardial infarction type I.

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  Fig. 2. Myocardial infarction type II.

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  Fig. 3. Coronary angiography of a patient with unstable angina pectoris. A, B. Caudal (A) and cranial (B) views of the left coronary artery show the eccentric luminal narrowing of the distal left main coaronary artery (arrows).

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  Fig. 4. Coronary angiography of a patient with unstable angina pectoris (A) and intravascular US finding (B). A. Coronary angiography shows the eccentric luminal narrowing of the distal left main coronary artery (arrow). B. Intravascular US shows the plaque rupture site with residual fibrous cap (arrowhead) and the remnant lipid core (asterisk).

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  Fig. 5. A representative case showing the usefulness of cardiac CT for a patient with non-ST segment elevation acute coronary syndrome. A. Cardiac CT of a 41-year-old male with acute chest pain shows moderate stenosis in the mid LAD (arrow). B. Coronary angiography after 1 day reveals severe stenosis of the proximal LAD (arrow corresponds to cardiac CT). LAD = left anterior descending artery

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  Fig. 6. A 75-year-old male with atypical chest pain and the napkin ring sign. A. A schematic diagram of a napkin ring sign shows a central lipid-rich portion and a peripheral fibrous portion. B. An multiplanar reconstruction image of the LAD on cardiac CT shows moderate stenosis (arrow). A cross-sectional image of the LAD on cardiac CT presents a central low-density plaque (corresponding to the schematic) surrounded by a relatively high-density plaque. C. After 6 months, the patient complained of acute chest pain, and coronary angiography shows severe stenosis of the proximal LAD (arrow corresponds to cardiac CT). C = central plaque, LAD = left anterior descending artery

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  Fig. 7. A 66-year-old male with atypical chest pain and positive remodeling of coronary arteris. A. A schematic diagram of positive remodeling of coronary arteries is shown; the EEM is greater for positive remodeling than that for normal coronary or negative remodeling. B. The volume rendering image of the LAD on cardiac CT shows moderate stenosis with a positive remodeling, corresponding to the cross-sectional image of the LAD on cardiac CT (a: normal segment, b: stenotic segment with positive remodeling). C. After 2 months, the patient complained of acute chest pain, and coronary angiography shows severe stenosis of the proximal LAD (arrow corresponds to cardiac CT). EEM = external elastic membrane, LAD = left anterior descending artery

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  Fig. 8. Spotty calcification (arrow) and macro-calcification (arrowhead) are shown.

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  Fig. 9. Perivascular fat attenuation. A. Areas with high perivascular fat attention (red color) occupy less than 10% of the measured perivascular area. B. Areas with high perivascular fat attention (red color) occupy more than 30% of the measured perivascular area. HU = Hounsfield unit