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Asymptomatic patient with chronic total occlusion of RCA-m

Case Study
Yun, Chun-Ho, M.D. Mackay Memorial Hospital • Taiwan
Tsai, Cheng-Ting, M.D. Mackay Memorial Hospital • Taiwan
Yang, Fei-Shih, M.D. Mackay Memorial Hospital • Taiwan

Patient history

62-year-old male with well-controlled hypertension, hyperlipidemia. Coronary CTA showed chronic total occlusion (CTO) of RCA-m. The patient had CTO of RCA-m for more than 3 years, without symptoms while playing tennis for 50 mins, 4 times per week.

MR examination

Achieva 3.0T with the 32-channel SENSE cardiac coil was used.

With persantine as a stressor, stress/rest perfusion was performed. Cine imaging of 2-chamber, 4-chamber and SAX is done, as well as delayed enhancement.
Multihance contrast medium was administered.
Total scan time was around 35 minutes.

Images

Chronic total occlusion of RCA-m on three               Chronic total occlusion of RCA-m on curved dimension volume rendering view.                          MPR view.
                                                              

No MRI evidence of non-viable myocardium at left ventricular wall.


Stress MR myocardial perfusion.

Diagnosis

No evidence of stress-inducible ischemia of the patient with CTO of RCA-m.

Clinical impact of cardiac MR stress testing

Usually SPECT is done for the non-invasive functional tests. If the nuclear medicine result is equivocal, this kind of asymptomatic patient will probably be sent to angioroom for intervention. However, with excellent imaging quality, the negative result of the patient in CMR is confirmed. The patient can keep his optimal medical therapy without receiving PCI.  

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Jun 5, 2012

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Case Study
Achieva 3.0T
32ch SENSE Cardiac coil, Cardiac, Cardiac function cine, cmr, coronaries, CTO, occlusion, RCA, stress test
 

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