Coronary plaque stabilization followed by Color Code Plaque analysis with 64-slice multidetector row computed tomography.

A 61-year-old woman with hypercholesterolemia, hypertension and diabetes mellitus was referred to hospital for the evaluation of chest pain at rest. Eccentric 50% stenosis in the proximal right coronary artery was detected by 64-slice multidetector row computed tomography (MDCT). The plaque morphology was considered as soft by Color Code Plaque (CCP) analysis. Seven days after MDCT, chest pain continued and transient ST-elevation was detected on the II-lead ECG monitor during echocardiography. Therefore, emergency coronary angiography was performed and confirmed the 50% stenosis as shown on MDCT. Her disease was diagnosed as vasospastic angina. For the purpose of plaque stabilization, lipid-lowering therapy with atorvastatin was instituted and her symptoms improved. After 11 months, serum total cholesterol and LDL-cholesterol levels were reduced. A second MDCT was performed and plaque morphology had changed from soft to intermediate. Cross-sectional multiplanar reconstruction of MDCT images indicated reduction of total vessel area, expansion of the lumen area and improvement of the remodeling index at the site of stenosis. The lipid-lowering therapy contributed to plaque stabilization, and CCP analysis by noninvasive MDCT was useful for plaque characterization. This case suggests that differences between vulnerable and stable plaques can be classified using MDCT to predict acute coronary syndrome.

Noninvasive assessment of coronary stents in patients by 16-slice computed tomography.

BACKGROUND: The usefulness of thin-slice multi-detector computed tomography (MDCT) has been highly expected to assess the lumens of coronary artery stents. We evaluated the usefulness of 16-slice MDCT to assess the in-stent lumen after coronary artery stenting. METHODS: In 42 consecutive patients after coronary artery stenting, retrospective ECG-gated CT-angiography using 16-slice MDCT (0.5-s rotation time, 16x0.625-mm detector collimation) was performed. The qualitative assessability of the lumens of 61 coronary stents (14 different types) by MDCT and the reasons for non-assessability were investigated. Furthermore, the evaluation of in-stent restenosis in 21 assessable stents of 16 patients, including quantitative density analysis by MDCT, was performed and the results were compared with those of conventional coronary angiography (CAG). RESULTS: Of 61 stents, 42 (68.9%) were assessable. The assessability of diameter > or =3.5-mm stents made of stainless steel or cobalt was high (88.6%, 31/35), that of 3.0-mm stents was low (57.9%, 11/19) and all 2.5-mm stents were non-assessable due to partial volume effects and metal artifacts of stents. The lumens of stents made of tantalum were totally obscured and the metal artifacts of Bestent2 (gold markers) and S670 were severer than others. All non-assessable stents due to banding artifact and calcification were implanted in segment #1-3 and #6, respectively. In comparison to CAG, MDCT correctly detected the 5 in-stent restenoses and identified absence of restenoses was influenced strongly by the stent strut. CONCLUSION: Despite some limitations, 16-slice MSCT is sufficiently useful for assessment of various coronary stents in patients and can detect in-stent restenoses of assessable stents with high accuracy in comparison to CAG.

Ability for visualization, reasons for nonassessable image, and diagnostic accuracy of 16-slice multidetector row helical computed tomography for the assessment of the entire coronary arteries.

It was demonstrated that 16-slice multidetector row helical computed tomography may permit more accurate assessment of entire coronary arteries, with a low rate of arteries unable to be evaluated. The detection of coronary artery stenoses with this modality was applicable to assessable segments.

[A case of acute renal failure with marked hyperuricemia developing during mizoribine administration].

A 50-year-old man diagnosed as having AGA(Churg-Strauss syndrome) was administered steroid. After treatment with mizoribine, hyperuricemia and acute renal failure occurred as side effects of this drug. Accordingly we started dialysis treatment, terminated mizoribine treatment, and administered allopurinol dosage. Hemodialysis was necessary every day for 11 days and his renal function recovered after one month. In 67Ga scintigraphy, accumulation of 67Ga was seen in the kidney.