CASE 5527 Published on 15.01.2007
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Coronary artery disease – Adenosine Perfusion

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Kokocinski T, Nagel E. German Heart Institute Berlin and cmr-academy 13353 Berlin, Germany eike.nagel@dhzb.de

Connected authors
Patient

67 years, male

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Clinical History
Presenting with typical angina pectoris
Imaging Findings
Patient is presenting to the outpatient department with typical angina pectoris. Risk factors are arterial hypertension, hyperlipoproteinemia and nicotine abuse. Ambiguous exercise ECG due to left ventricular hypertrophy. Stress MR imaging was ordered due to insufficient echocardiographic image quality. MR imaging consisted of wall motion at rest, adenosine stress perfusion (140µg adenosine /kg body weight for 4 minutes, 0.05 mmol Gd-DTPA-BOPTA/kg body weight), rest perfusion after 10 minutes (0.05 mmol Gd-DTPA-BOPTA/kg body weight), and late Gd enhancement after 10 minutes. Wall motion was normal (Figure 1). Perfusion imaging showed an adenosine induced defect in the inferior segments (apical, equatorial and basal) of up to 75% transmurality (Figure 2=stress; Figure 3 = rest) . Late Gd enhancement did not reveal any scar tissue (Figure 4). A significant stenosis of the right coronary artery was diagnosed from the MR examination. Proximal stenosis and distal occlusion of the right coronary artery was confirmed by invasive angiography (Figure 5).
Discussion
Male patients aged 60-69 with typical angina pectoris have a pre-test probability of more than 90% for significant coronary artery disease. Typical angina pectoris is defined as substernal chest pain of discomfort that is provoked by exertion or emotion al stress and relieved by rest and / or nitroglycerin. In such patients imaging is mainly performed to determine the severity of stenoses as well as the leading stenosis in cases of multi vessel disease. In addition, it is useful to perform late Gd enhancement imaging which improves the accuracy of perfusion imaging and may detect previously unknown myocardial infarction. MR is superior to SPECT imaging, mainly due to the higher spatial resolution allowing for an accurate assessment of the transmurality of ischemia. For the assessment of extent and location of disease perfusion imaging is superior to dobutamine stress.
Differential Diagnosis List
Significant right coronary artery stenosis.
Final Diagnosis
Significant right coronary artery stenosis.
Case information
URL: https://eurorad.org/case/5527
DOI: 10.1594/EURORAD/CASE.5527
ISSN: 1563-4086
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