2009) have allowed enhanced temporal and spatial resolutions, the images from which could be further enhanced with the use of image reconstruction and analysis software (Gopal et al. 2009).
The diagnostic value of MDCTA is in the ability to diagnose small-volume plaque of soft consistency since in most cases (Manghat et al. 2005), since the acute coronary syndromes result from the rupture of these plaques (Manghat et al. 2005). Thus it remains to be investigated in the following case study about how these three parameters may lead to a specific protocol for imaging in the following case.
This is a case of a 56-year-old man who presented to the hospital with a history of chest pain suggesting crescendo angina pectoris for a duration of 48 hours. Previous ECG demonstrated labile changes with transient ST segment elevation that settled to deep anterior-inferior ST depression. Primary percutaneous intervention was futile since noslective injection of the cusp failed to detect the ostia of the right and left coronary arteries. An echocardiography done on the table suggested features of acute aortic root dissection indicated by a dilated aortic root. It was decided that an emergency 64-slice multidetector row CT (MDCTA) would be performed, which revealed in the gated scan of thoracic aorta and the coronary arteries that there was a single coronary ostium with anomalous origin higher and anterior from the suprasinotubular ridge. From this anomalous ostium, two vessels arose, one a small anomalous left anterior descending artery and a common trunk that eventually trifurcated into a large anomalous circumflex artery, right coronary artery, and a small septal branch. The culprit lesion was located within the anomalous circumflex artery, which proved to be a noncalcified atherosclerotic plaque. A repeat coronary angiography done with a 6 Fr Amplatz left 1 guidewire reconfirmed these findings, in which setting; a direct stenting was performed leading to excellent recovery of the patient.
This case exemplifies the clinical utility of MDCTA in that it could detect a rare anomaly of the coronary artery anatomy. In any other investigative modality, it would have been very difficult to detect multiple vessels arising from a location higher than usual, more so from a single coronary artery ostium. MDCTA provided the clinical imaging pathway for mapping these anomalous coronary arteries with localisation of the site of unstable plaque, and obviously, this facilitated rapid diagnosis, treatment; prevented complications; and improved prognosis (Becker 2002).
Pathology: Coronary Artery Disease (CAD)
The main indication for which CT angiography is done is to detect and diagnose atherosclerotic coronary artery disease (Schindler 2010). This is the main cause of coronary artery disease. Normally myocardium is highly active tissue, and it is in need of continuous and consistent blood supply through which nutrients and oxygen reach the myocardium (Pontone et al. 2007). When atherosclerosis occurs as a pathological lesion in these arteries, the major physiological problem that occurs is deficiency in blood supply to the myocardium due to narrowing in a segment of the artery due to deposition of fatty plaques (Libby 2002).
It has been observed that when atherosclerotic coronary lesions occur, primarily there is accumulation and oxidation of