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Current Concepts in Multi–Detector Row CT Evaluation of the Coronary Arteries: Principles, Techniques, and Anatomy¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Md (H.K.P., F.M.C., E.K.F.); and the CT Division, Siemens Medical Solutions, Forchheim, Germany (T.G.F.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received March 5, 2003; revision requested April 16 and received May 21; accepted May 29. T.G.F. is an employee of Siemens Medical Solutions. E.K.F. is a consultant to the CT Advisory Board. Address correspondence to H.K.P., Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287 (e-mail: hpannu1@jhmi.edu).

View larger version (97K): [in a new window]   Figure 1a.  Techniques of retrospective image reconstruction. (a) ECG strip shows the relative delay method, in which a certain delay from the prior wave is determined as a percentage of the R-R interval. This delay is used to start reconstruction. (b) ECG strip shows the absolute delay method, in which a fixed time delay after the R wave determines the start of reconstruction. (c) ECG strip shows the absolute reverse method, in which a fixed time before the next R wave determines the start of reconstruction.

View larger version (98K): [in a new window]   Figure 1b.  Techniques of retrospective image reconstruction. (a) ECG strip shows the relative delay method, in which a certain delay from the prior wave is determined as a percentage of the R-R interval. This delay is used to start reconstruction. (b) ECG strip shows the absolute delay method, in which a fixed time delay after the R wave determines the start of reconstruction. (c) ECG strip shows the absolute reverse method, in which a fixed time before the next R wave determines the start of reconstruction.

View larger version (97K): [in a new window]   Figure 1c.  Techniques of retrospective image reconstruction. (a) ECG strip shows the relative delay method, in which a certain delay from the prior wave is determined as a percentage of the R-R interval. This delay is used to start reconstruction. (b) ECG strip shows the absolute delay method, in which a fixed time delay after the R wave determines the start of reconstruction. (c) ECG strip shows the absolute reverse method, in which a fixed time before the next R wave determines the start of reconstruction.

View larger version (157K): [in a new window]   Figure 2a.  Coronary artery anatomy at CT. In all figures, A = aorta, LA = left atrium, LV = left ventricle, P = pulmonary trunk. (a) Oblique volume-rendered image of the top of the heart shows the origins of the right (arrow) and left (arrowhead) main coronary arteries, which demonstrate high-attenuation calcifications. (b, c) Coronal oblique volume-rendered (b) and maximum intensity projection (c) images of the anterior heart show the right (arrow) and left (arrowhead) coronary arteries.

View larger version (144K): [in a new window]   Figure 2b.  Coronary artery anatomy at CT. In all figures, A = aorta, LA = left atrium, LV = left ventricle, P = pulmonary trunk. (a) Oblique volume-rendered image of the top of the heart shows the origins of the right (arrow) and left (arrowhead) main coronary arteries, which demonstrate high-attenuation calcifications. (b, c) Coronal oblique volume-rendered (b) and maximum intensity projection (c) images of the anterior heart show the right (arrow) and left (arrowhead) coronary arteries.

View larger version (89K): [in a new window]   Figure 2c.  Coronary artery anatomy at CT. In all figures, A = aorta, LA = left atrium, LV = left ventricle, P = pulmonary trunk. (a) Oblique volume-rendered image of the top of the heart shows the origins of the right (arrow) and left (arrowhead) main coronary arteries, which demonstrate high-attenuation calcifications. (b, c) Coronal oblique volume-rendered (b) and maximum intensity projection (c) images of the anterior heart show the right (arrow) and left (arrowhead) coronary arteries.

View larger version (146K): [in a new window]   Figure 3a.  RCA. (a) Axial CT image shows origin of the RCA (arrow) from the aorta and extension into the right atrioventricular groove. The artery is minimally calcified. (b) Coronal oblique volume-rendered image shows the caudal course of the proximal RCA (arrow). (c) Coronal oblique volume-rendered image shows the RCA (arrow) coursing in the groove between the right atrium (RA) and right ventricle (RV). (d) Coronal oblique volume-rendered image shows the course of the RCA (arrow) posterior to the pulmonary trunk. (e) Posterior coronal oblique volume-rendered image shows the RCA (long arrow), PDA branch (short arrow), and posterolateral left ventricular branch (arrowhead).

View larger version (114K): [in a new window]   Figure 3b.  RCA. (a) Axial CT image shows origin of the RCA (arrow) from the aorta and extension into the right atrioventricular groove. The artery is minimally calcified. (b) Coronal oblique volume-rendered image shows the caudal course of the proximal RCA (arrow). (c) Coronal oblique volume-rendered image shows the RCA (arrow) coursing in the groove between the right atrium (RA) and right ventricle (RV). (d) Coronal oblique volume-rendered image shows the course of the RCA (arrow) posterior to the pulmonary trunk. (e) Posterior coronal oblique volume-rendered image shows the RCA (long arrow), PDA branch (short arrow), and posterolateral left ventricular branch (arrowhead).

View larger version (129K): [in a new window]   Figure 3c.  RCA. (a) Axial CT image shows origin of the RCA (arrow) from the aorta and extension into the right atrioventricular groove. The artery is minimally calcified. (b) Coronal oblique volume-rendered image shows the caudal course of the proximal RCA (arrow). (c) Coronal oblique volume-rendered image shows the RCA (arrow) coursing in the groove between the right atrium (RA) and right ventricle (RV). (d) Coronal oblique volume-rendered image shows the course of the RCA (arrow) posterior to the pulmonary trunk. (e) Posterior coronal oblique volume-rendered image shows the RCA (long arrow), PDA branch (short arrow), and posterolateral left ventricular branch (arrowhead).

View larger version (140K): [in a new window]   Figure 3d.  RCA. (a) Axial CT image shows origin of the RCA (arrow) from the aorta and extension into the right atrioventricular groove. The artery is minimally calcified. (b) Coronal oblique volume-rendered image shows the caudal course of the proximal RCA (arrow). (c) Coronal oblique volume-rendered image shows the RCA (arrow) coursing in the groove between the right atrium (RA) and right ventricle (RV). (d) Coronal oblique volume-rendered image shows the course of the RCA (arrow) posterior to the pulmonary trunk. (e) Posterior coronal oblique volume-rendered image shows the RCA (long arrow), PDA branch (short arrow), and posterolateral left ventricular branch (arrowhead).

View larger version (140K): [in a new window]   Figure 3e.  RCA. (a) Axial CT image shows origin of the RCA (arrow) from the aorta and extension into the right atrioventricular groove. The artery is minimally calcified. (b) Coronal oblique volume-rendered image shows the caudal course of the proximal RCA (arrow). (c) Coronal oblique volume-rendered image shows the RCA (arrow) coursing in the groove between the right atrium (RA) and right ventricle (RV). (d) Coronal oblique volume-rendered image shows the course of the RCA (arrow) posterior to the pulmonary trunk. (e) Posterior coronal oblique volume-rendered image shows the RCA (long arrow), PDA branch (short arrow), and posterolateral left ventricular branch (arrowhead).

View larger version (139K): [in a new window]   Figure 4a.  PDA. (a, b) Coronal oblique maximum intensity projection images show the PDA branch (arrow) and posterolateral left ventricular branches (arrowheads) of the RCA. (c, d) Axial oblique (c) and posterior coronal (d) volume-rendered images show the PDA (arrow) coursing in the posterior interventricular groove and the posterolateral left ventricular branch (arrowhead). RV = right ventricle.

View larger version (141K): [in a new window]   Figure 4b.  PDA. (a, b) Coronal oblique maximum intensity projection images show the PDA branch (arrow) and posterolateral left ventricular branches (arrowheads) of the RCA. (c, d) Axial oblique (c) and posterior coronal (d) volume-rendered images show the PDA (arrow) coursing in the posterior interventricular groove and the posterolateral left ventricular branch (arrowhead). RV = right ventricle.

View larger version (158K): [in a new window]   Figure 4c.  PDA. (a, b) Coronal oblique maximum intensity projection images show the PDA branch (arrow) and posterolateral left ventricular branches (arrowheads) of the RCA. (c, d) Axial oblique (c) and posterior coronal (d) volume-rendered images show the PDA (arrow) coursing in the posterior interventricular groove and the posterolateral left ventricular branch (arrowhead). RV = right ventricle.

View larger version (151K): [in a new window]   Figure 4d.  PDA. (a, b) Coronal oblique maximum intensity projection images show the PDA branch (arrow) and posterolateral left ventricular branches (arrowheads) of the RCA. (c, d) Axial oblique (c) and posterior coronal (d) volume-rendered images show the PDA (arrow) coursing in the posterior interventricular groove and the posterolateral left ventricular branch (arrowhead). RV = right ventricle.

View larger version (136K): [in a new window]   Figure 5a.  Left main coronary artery. (a) Axial CT image shows origin of the left main coronary artery (arrow) from the aorta. (b-d) Axial oblique (b) and coronal oblique (c, d) volume-rendered images show bifurcation of the left main coronary artery (black arrow). The LAD artery and diagonal branches (white arrows) and the LCX artery (arrowhead) are also seen. High-attenuation areas in the vessels represent calcifications.

View larger version (133K): [in a new window]   Figure 5b.  Left main coronary artery. (a) Axial CT image shows origin of the left main coronary artery (arrow) from the aorta. (b-d) Axial oblique (b) and coronal oblique (c, d) volume-rendered images show bifurcation of the left main coronary artery (black arrow). The LAD artery and diagonal branches (white arrows) and the LCX artery (arrowhead) are also seen. High-attenuation areas in the vessels represent calcifications.

View larger version (157K): [in a new window]   Figure 5c.  Left main coronary artery. (a) Axial CT image shows origin of the left main coronary artery (arrow) from the aorta. (b-d) Axial oblique (b) and coronal oblique (c, d) volume-rendered images show bifurcation of the left main coronary artery (black arrow). The LAD artery and diagonal branches (white arrows) and the LCX artery (arrowhead) are also seen. High-attenuation areas in the vessels represent calcifications.

View larger version (139K): [in a new window]   Figure 5d.  Left main coronary artery. (a) Axial CT image shows origin of the left main coronary artery (arrow) from the aorta. (b-d) Axial oblique (b) and coronal oblique (c, d) volume-rendered images show bifurcation of the left main coronary artery (black arrow). The LAD artery and diagonal branches (white arrows) and the LCX artery (arrowhead) are also seen. High-attenuation areas in the vessels represent calcifications.

View larger version (149K): [in a new window]   Figure 6a.  LAD artery. Oblique (a, b) and lateral (c) volume-rendered images show diagonal branches (arrowheads) of the LAD artery (arrow in a).

View larger version (152K): [in a new window]   Figure 6b.  LAD artery. Oblique (a, b) and lateral (c) volume-rendered images show diagonal branches (arrowheads) of the LAD artery (arrow in a).

View larger version (113K): [in a new window]   Figure 6c.  LAD artery. Oblique (a, b) and lateral (c) volume-rendered images show diagonal branches (arrowheads) of the LAD artery (arrow in a).

View larger version (141K): [in a new window]   Figure 7a.  LCX artery. (a) Axial CT image shows the LCX artery (straight solid arrow) in the left atrioventricular groove, the RCA (open arrow) in the right atrioventricular groove, and the LAD artery (curved arrow) coursing toward the apex of the heart. (b-d) Coronal oblique volume-rendered image (b), oblique volume-rendered image of the top of the heart (c), and axial oblique volume-rendered image (d) show the LCX artery (arrow) in the left atrioventricular groove and obtuse marginal branches (arrowhead) to the lateral left ventricle.

View larger version (149K): [in a new window]   Figure 7b.  LCX artery. (a) Axial CT image shows the LCX artery (straight solid arrow) in the left atrioventricular groove, the RCA (open arrow) in the right atrioventricular groove, and the LAD artery (curved arrow) coursing toward the apex of the heart. (b-d) Coronal oblique volume-rendered image (b), oblique volume-rendered image of the top of the heart (c), and axial oblique volume-rendered image (d) show the LCX artery (arrow) in the left atrioventricular groove and obtuse marginal branches (arrowhead) to the lateral left ventricle.

View larger version (160K): [in a new window]   Figure 7c.  LCX artery. (a) Axial CT image shows the LCX artery (straight solid arrow) in the left atrioventricular groove, the RCA (open arrow) in the right atrioventricular groove, and the LAD artery (curved arrow) coursing toward the apex of the heart. (b-d) Coronal oblique volume-rendered image (b), oblique volume-rendered image of the top of the heart (c), and axial oblique volume-rendered image (d) show the LCX artery (arrow) in the left atrioventricular groove and obtuse marginal branches (arrowhead) to the lateral left ventricle.

View larger version (159K): [in a new window]   Figure 7d.  LCX artery. (a) Axial CT image shows the LCX artery (straight solid arrow) in the left atrioventricular groove, the RCA (open arrow) in the right atrioventricular groove, and the LAD artery (curved arrow) coursing toward the apex of the heart. (b-d) Coronal oblique volume-rendered image (b), oblique volume-rendered image of the top of the heart (c), and axial oblique volume-rendered image (d) show the LCX artery (arrow) in the left atrioventricular groove and obtuse marginal branches (arrowhead) to the lateral left ventricle.