Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

CT Imaging Findings in Non-Atherosclerotic Coronary Artery Disease

다양한 비죽상경화 관상동맥 질환의 CT 영상 소견

  • Jongmin Park (Department of Radiology, School of Medicine, Kyungpook National University) ;
  • Byunggeon Park (Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital) ;
  • Eun-Ju Kang (Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine) ;
  • Jongmin Lee (Department of Radiology, School of Medicine, Kyungpook National University)
  • 박종민 (경북대학교 의과대학 영상의학교실) ;
  • 박병건 (경북대학교 의과대학 경북대학교 칠곡병원 영상의학과) ;
  • 강은주 (동아대학교 의과대학 동아대학교의료원 영상의학과) ;
  • 이종민 (경북대학교 의과대학 영상의학교실)
  • Received : 2021.10.13
  • Accepted : 2022.01.07
  • Published : 2022.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Acute coronary syndrome (ACS) is mainly caused by atherosclerotic coronary artery disease (CAD); however, it can also occur in patients with non-atherosclerotic CAD. Conventional coronary angiography only shows the lumen of arteries, indicating the presence of stenosis or dilatation. Thus, it has limited value in evaluating the coronary artery wall and offers low specificity for diagnosing CAD. Coronary CT angiography provides additional information, including the depiction of the concerned vessel and the aorta, as well as the pulmonary artery, which permits the diagnosis of non-atherosclerotic CAD and the differentiation of various causes of the disease. In this review, we present the pathophysiology and CT imaging features of non-atherosclerotic CAD.

급성 관동맥 증후군(acute coronary syndrome)은 대부분 죽상경화 관상동맥 질환(atherosclerotic coronary artery disease)에 의해 발생하지만, 비죽상경화 관상동맥 질환에서도 발생할 수 있다. 고식적 관상동맥 혈관조영술은 동맥 내강의 협착이나 확장 등의 형상에 대한 정보만을 제공하고, 동맥경화반이나 동맥벽에 대한 평가가 어려워 관상동맥 이상의 원인 질환의 진단에 낮은 특이도를 보인다. 반면, 관상동맥 전산화단층촬영 혈관조영술은 혈관경화반의 특징, 혈관벽의 조영증강뿐 아니라 연접한 대동맥이나 폐동맥의 변화 등도 함께 관찰할 수 있어, 비죽상경화 관상상동맥질환의 진단 및 다양한 원인 감별에 도움이 된다. 따라서 이종설에서는 다양한 비죽상경화 관상동맥 질환들을 소개하고, 이의 병태생리 및 대표적인 관상동맥 전산화단층촬영 혈관조영술의 영상 소견에 대해 설명하고자 한다.

Keywords

References

  1. Higuma T, Soeda T, Abe N, Yamada M, Yokoyama H, Shibutani S, et al. A combined optical coherence tomography and intravascular ultrasound study on plaque rupture, plaque erosion, and calcified nodule in patients with ST-segment elevation myocardial infarction: incidence, morphologic characteristics, and outcomes after percutaneous coronary intervention. JACC Cardiovasc Interv 2015;8:1166-1176 
  2. Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med 1999;341:226-232 
  3. Waterbury TM, Tarantini G, Vogel B, Mehran R, Gersh BJ, Gulati R. Non-atherosclerotic causes of acute coronary syndromes. Nat Rev Cardiol 2020;17:229-241 
  4. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003 
  5. Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2010;56:1864-1894 
  6. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 2008;52:1724-1732 
  7. Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment. J Cardiol 2008;51:2-17 
  8. Hung MJ, Hu P, Hung MY. Coronary artery spasm: review and update. Int J Med Sci 2014;11:1161-1171 
  9. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013). Circ J 2014:78:2779-2801 
  10. Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation 1993;87:76-79 
  11. Morrow JD, Frei B, Longmire AW, Gaziano JM, Lynch SM, Shyr Y, et al. Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers. Smoking as a cause of oxidative damage. N Engl J Med 1995;332:1198-1203 
  12. Fernandez D, Rosenthal JE, Cohen LS, Hammond G, Wolfson S. Alcohol-induced Prinzmetal variant angina. Am J Cardiol 1973;32:238-239 
  13. Takaoka K, Yoshimura M, Ogawa H, Kugiyama K, Nakayama M, Shimasaki Y, et al. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol 2000;72:121-126 
  14. Vanhoutte PM, Shimokawa H. Endothelium-derived relaxing factor and coronary vasospasm. Circulation 1989;80:1-9 
  15. Miwa K, Kishimoto C, Nakamura H, Makita T, Ishii K, Okuda N, et al. Increased oxidative stress with elevated serum thioredoxin level in patients with coronary spastic angina. Clin Cardiol 2003;26:177-181 
  16. Farag A, Al-Najjar Y, Eichhofer J. Adenosine-induced vasospasticity in a myocardial bridge...endothelial dysfunction? JACC Cardiovasc Interv 2015;8:e21-e22 
  17. Nam P, Choi BG, Choi SY, Byun JK, Mashaly A, Park Y, et al. The impact of myocardial bridge on coronary artery spasm and long-term clinical outcomes in patients without significant atherosclerotic stenosis. Atherosclerosis 2018;270:8-12 
  18. Duygu H. A bridge to coronary spasm: myocardial bridging. Int J Cardiol 2016;214:35-36 
  19. Kim JW, Park CG, Suh SY, Choi CU, Kim EJ, Rha SW, et al. Comparison of frequency of coronary spasm in Korean patients with versus without myocardial bridging. Am J Cardiol 2007;100:1083-1086 
  20. Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 2017;38:2565-2568 
  21. Araki H, Koiwaya Y, Nakagaki O, Nakamura M. Diurnal distribution of ST-segment elevation and related arrhythmias in patients with variant angina: a study by ambulatory ECG monitoring. Circulation 1983;67:995-1000 
  22. Feldman RL, Hill JA, Whittle JL, Conti CR, Pepine CJ. Electrocardiographic changes with coronary artery spasm. Am Heart J 1983;106:1288-1297 
  23. Szlachcic J, Waters DD, Miller D, Theroux P. Ventricular arrhythmias during ergonovine-induced episodes of variant angina. Am Heart J 1984;107:20-24 
  24. Ito T, Terashima M, Kaneda H, Nasu K, Ehara M, Kinoshita Y, et al. In vivo assessment of ergonovine-induced coronary artery spasm by 64-slice multislice computed tomography. Circ Cardiovasc Imaging 2012;5:226-232 
  25. Kang KM, Choi SI, Chun EJ, Kim JA, Youn TJ, Choi DJ. Coronary vasospastic angina: assessment by multidetector CT coronary angiography. Korean J Radiol 2012;13:27-33 
  26. Park J, Kim HK, Park EA, Park JB, Lee SP, Lee W, et al. Coronary computed tomography angiography for the diagnosis of vasospastic angina: comparison with invasive coronary angiography and ergonovine provocation test. Korean J Radiol 2019;20:719-728 
  27. Kang EJ, Kim MH, De Jin C, Seo J, Kim DW, Yoon SK, et al. Noninvasive detection of coronary vasospastic angina using a double-acquisition coronary CT angiography protocol in the presence and absence of an intravenous nitrate: a pilot study. Eur Radiol 2017;27:1136-1147 
  28. Kim ESH. Spontaneous coronary-artery dissection. N Engl J Med 2020;383:2358-2370 
  29. Adlam D, Alfonso F, Maas A, Vrints C; Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 2018;39:3353-3368 
  30. Kok SN, Hayes SN, Cutrer FM, Raphael CE, Gulati R, Best PJM, et al. Prevalence and clinical factors of migraine in patients with spontaneous coronary artery dissection. J Am Heart Assoc 2018;7:e010140 
  31. Smilowitz NR, Gupta N, Guo Y, Zhong J, Weinberg CR, Reynolds HR, et al. Acute myocardial infarction during pregnancy and the puerperium in the United States. Mayo Clin Proc 2018;93:1404-1414 
  32. Gupta S, Meyersohn NM, Wood MJ, Steigner ML, Blankstein R, Ghoshhajra BB, et al. Role of coronary CT angiography in spontaneous coronary artery dissection. Radiol Cardiothorac Imaging 2020;2:e200364 
  33. Sharma S, Kaadan MI, Duran JM, Ponzini F, Mishra S, Tsiaras SV, et al. Risk factors, imaging findings, and sex differences in spontaneous coronary artery dissection. Am J Cardiol 2019;123:1783-1787 
  34. Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V, et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol 2012;59:1073-1079 
  35. Maehara A, Mintz GS, Castagna MT, Pichard AD, Satler LF, Waksman R, et al. Intravascular ultrasound assessment of spontaneous coronary artery dissection. Am J Cardiol 2002;89:466-468 
  36. Eleid MF, Tweet MS, Young PM, Williamson E, Hayes SN, Gulati R. Spontaneous coronary artery dissection: challenges of coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care 2018;7:609-613 
  37. Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, Kanaya T, et al. Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary artery embolism. Circulation 2015;132:241-250 
  38. Lacunza-Ruiz FJ, Munoz-Esparza C, Garcia-de-Lara J. Coronary embolism and thrombosis of prosthetic mitral valve. JACC Cardiovasc Interv 2014;7:e127-e128 
  39. Raphael CE, Heit JA, Reeder GS, Bois MC, Maleszewski JJ, Tilbury RT, et al. Coronary embolus: an underappreciated cause of acute coronary syndromes. JACC Cardiovasc Interv 2018;11:172-180 
  40. Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 2011;196:W678-W682 
  41. Rife E, Gedalia A. Kawasaki disease: an update. Curr Rheumatol Rep 2020;22:75 
  42. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis Rheum 2013;65:1-11 
  43. Uehara R, Belay ED, Maddox RA, Holman RC, Nakamura Y, Yashiro M, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediatr Infect Dis J 2008;27:155-160 
  44. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-1385 
  45. Research Committee on Kawasaki Disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo: Ministry of Health and Welfare 1984 
  46. Nakamura Y. Kawasaki disease: epidemiology and the lessons from it. Int J Rheum Dis 2018;21:16-19 
  47. Thangathurai J, Kalashnikova M, Takahashi M, Shinbane JS. Coronary artery aneurysm in Kawasaki disease: coronary CT angiography through the lens of pathophysiology and differential diagnosis. Radiol Cardiothorac Imaging 2021;3:e200550 
  48. Hoshino S, Tsuda E, Yamada O. Characteristics and fate of systemic artery aneurysm after Kawasaki disease. J Pediatr 2015;167:108-112.e1-e2 
  49. Orenstein JM, Shulman ST, Fox LM, Baker SC, Takahashi M, Bhatti TR, et al. Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study. PLoS One 2012;7:e38998 
  50. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135:e927-e999 
  51. Levin DC, Fellows KE, Abrams HL. Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation 1978;58:25-34 
  52. Jeudy J, White CS, Kligerman SJ, Killam JL, Burke AP, Sechrist JW, et al. Spectrum of coronary artery aneurysms: from the radiologic pathology archives. Radiographics 2018;38:11-36 
  53. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med 1994;120:919-929 
  54. Onen F, Akkoc N. Epidemiology of Takayasu arteritis. Presse Med 2017;46:e197-e203 
  55. Endo M, Tomizawa Y, Nishida H, Aomi S, Nakazawa M, Tsurumi Y, et al. Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg 2003;125:570-577 
  56. Kang EJ, Kim SM, Choe YH, Lee GY, Lee KN, Kim DK. Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual-source CT angiography of the coronary arteries and aorta. Radiology 2014;270:74-81 
  57. Restrepo CS, Ocazionez D, Suri R, Vargas D. Aortitis: imaging spectrum of the infectious and inflammatory conditions of the aorta. Radiographics 2011;31:435-451 
  58. Khandelwal N, Kalra N, Garg MK, Kang M, Lal A, Jain S, et al. Multidetector CT angiography in Takayasu arteritis. Eur J Radiol 2011;77:369-374 
  59. Yamato M, Lecky JW, Hiramatsu K, Kohda E. Takayasu arteritis: radiographic and angiographic findings in 59 patients. Radiology 1986;161:329-334 
  60. Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, et al. CT features of vasculitides based on the 2012 International Chapel Hill Consensus Conference revised classification. Korean J Radiol 2017;18:786-798