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Cardiac MR of chronic total occlusion, double vessel disease

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

A 57-year-old male with dyspnea on excertion and risk factors smoking, hypertension, hyperlipidemia and age, underwent cardiac MR stress testing at Mackay Memorial Hospital.

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

Occluded LAD-m on angiography.                          Occluded LCx-m and severe stenosis at                                                                           diagonal on angiography.
Extensive stress-inducible ischemia at the left ventricular wall.



Minimal subendocardial non-viable tissue at anterior and lateral wall of left ventricle.


Peri-infarcted ischemia.

Diagnosis

Extensive stress-inducible ischemia at anterior and lateral wall of left ventricle. Peri-infarcted ischemia is identified at the basal lateral wall of the left ventricle.

Clinical impact of cardiac MR stress testing

In this case, identifying the stress-inducible ischemia may not be difficult for other modalities like SPECT as well, but seeing the peri-infarcted ischemia at basal lateral wall is probably only possible with Cardiac MRI. Using CMR, we could give the interventional cardiologist precise information on the viability of the left ventricular wall and avoid intervention in the vessel supplying the transmural non-viable segment.

Related reading



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Jun 5, 2012

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Case Study
Achieva 3.0T
32ch SENSE Cardiac coil, Cardiac, Cardiac function, CMR, CTO, Ischemia, stress test
 

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