1.Diffuse vasospasm in the coronary artery
Fig. 1
Fig. 2
52-year-old man,
acute chest pain.
Compared with previous cardiac CT (A),
follow-up CT (B) showed diffuse severe stenosis at proximal LAD and concentric stenosis,
rapidly progress for 2 months suggestive of variant angina .
On coronary arteriography ,
there was no remakable finding in the baseline study (C),
but diffuse stenosis was provoked with ergonovine,
(D),
which was relieved with nitroglycerin administration (E).
2.
Typical focal vasospasm without significant atheroma in the coronary artery
Fig. 3
41-year-old man with acute chest pain.
Significant discrete stenosis is noted in middle segment of left anterior descending artery on volume rendering image (A),
short-axis multiplanar image (B),
and curved multiplanar multidetector CT coronary angiography images (C).
However,
there is
no discernable atheroma in related segment.
On CAG,
mild luminal irregularity is shown at left anterior descending artery on baseline study(D).
However,
provoked tight stenosis occurs at same site on coronary angiography after administration of ergonovine (E).
3.
Focal coronary artery vasospasm with associated myocardial infarction
Fig. 4
64-year-old male with chest pain
Significant discrete stenosis is noted in middle segment of left anterior descending artery on volume rendering image (A),
short-axis multi-planar image (B),
and curved multi-planar multi-detector CT coronary angiography images (C).
(D),
(E) Hypokinesia at apical anterior and anteroseptal wall ,
suggesting myocardial infarction.
(CAG) 70-80% stenosis in the baseline study (F) ,
Relieved stenosis with nitroglycerin administration (G).
4.
Focal vasospasm with underlying atheroma (fixed lesion) in the coronary artery
Fig. 5
52-year-old male
Discrete stenosis is noted in middle segment of left anterior descending artery (A),(B) and intraluminal eccentric low attenuating lesion suggesting atheroma
(CAG) Stenotic lesion was shown in the base line study(C) and aggravated when provoked(D).But the lesion was relieved under nitroglycerin administration (E).
DISCUSSION
Variant angina shows a decrease in the luminal diameter,
in association with clinical symptoms and/or ECG changes on the conventional CAG with an EG test.
However,
there were little data on imaging findings by MDCT in assessment of VA.
Kang et al reported that cardiac MDCT showed low sensitivity and NPV in assessment of VA,
even though good diagnostic accuracy with high specificity and PPV was revealed.
Therefore,
cardiac MDCT cannot be used as an initial screening tool for evaluation of VA in a routine clinical practice.
Coronary vasospasm is transient,
often lasting only a few seconds,
and is unpredictable.
And that is why examination during the attack is important.
Therefore,
cardiac MDCT might be helpful in differentiation of the cause of acute chest pain,
especially in the emergency room.
In addition,
the possibility of VA should be considered in patients with acute chest pain if characteristic findings of VA on cardiac MDCT will be shown