Case of the week Details

• Fig 1 (Axial), Fig 2 (Sagittal oblique), Fig 3 (Coronal oblique) demonstrate mixed plaque in proximal and mid portions of right coronary artery causing 70-99 % occlusion (arrows) for a distance of about 1.2 cm. Rest portion of mid right coronary artery is attenuated.

DIAGNOSIS:

CADRADS 4A : 70 – 99 % stenosis (severe stenosis) in proximal to mid portions of right coronary artery – invasive coronary angiography is recommended.

DISCUSSION:

Behçet disease is a multisystemic and chronic relapsing inflammatory disorder characterized by the histopathologic finding of nonspecific vasculitis involving various sized vessels in multiple organs.

• The Coronary Artery Disease – Reporting and Data System (CAD-RADS) is a standardized findings communication method and clinical decision aid relevant to coronary CT angiography.
• CAD-RADS categories depend on stenosis severity.
• For the grading of stenosis severity, a classification system suggested by the Society of Cardiovascular Computed Tomography (SCCT) is used as seen in the table below.

REFERENCES:

1. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, Rybicki FJ. CAD-RADSTM coronary artery disease–reporting and data system. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. Journal of cardiovascular computed tomography. 2016 Jul 1;10(4):269-81.

Dr. Deepali Saxena,
DNB, Fellowship Cardiothoracic Imaging (USA)
Lead Cardiothoracic Imaging
Manipal Hospitals Radiology Group.
Unit coordinator, Whitefield

Dr. Vivek Jirankali,
MD
Senior resident and cross-sectional fellow
Manipal Hospitals Radiology Group.