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Okay, in this next case we're going to evaluate a patient

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who has mild calcified coronary artery

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disease the history for this patient abnormal EKG

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hypertension and hyperlipidemia,

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and they want to evaluate for potential coronary disease.

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So as we scroll down on the axial images

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We see the left meaningless patient looks for your disease.

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And then right away we get into the proximal LED and

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you see this big house by black. So I mentioned

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that it's important to window appropriately when

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you're assessing these lesions.

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Because you know when you have a more narrow window sometimes calcium

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can hide and be

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obscured by the bright contrast in

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the lumen.

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And the other thing is when you have a lot of calcium actually want

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to narrow even wider to make the

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calcium blooming minimize as much as possible. So,

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you know, if you're normally assessing on say a

0:59

window something like this when you get a lot

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of calcium, you want to even go even wider with

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your window.

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To minimize the volume of that

1:09

calcium as much as possible.

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Now let's just keep going through the LED to complete our

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assessment. It looks like this patient has a ramus see this

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big Branch here coming off of a trifurcation of the

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left Main.

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And it's a good size remix. So we definitely want to take a look at that for disease

1:25

and I'll see any so far and then you can see which is

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often the case the circumflex beyond the ramus is not

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as big as the LED. So it's a smaller vessel.

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And heads down there gives off an tooth

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marginal and kind of Peters out.

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So if we finish our assessment of the LED heading

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back to this proximal calcified black, we're going to look at that again on

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the CPR images.

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So as we continue Downstream in the LED, you can

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see there's a small diagonal Branch here which comes off LED

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kind of takes a little bit but torch was course it

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continues this way. I'll give you all the branch

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that way.

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And then heads down towards the Apex.

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I really like using the mips for assessing the

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LED and for assessing the diagonal branches. So if

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you trigger the mips in these patients.

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You can see that a lot of times. They'll show you a really

2:20

nice.

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visualization of the origins of the diagonals as

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they come off the LED

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In can help you see that idea as

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it heads down to the Apex.

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This patient also we can just point out as an aside. They've got a

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nice right dominant coronary circulation. You can see with the

2:39

mips really nicely that the patient has.

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A PDA Branch right here as well as some postural

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ventricular branches.

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And this is a bit of a variant in normal coronary anatomy

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where you can actually see that the branch for the PDA.

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Comes off pretty early in the distal RCA and heads

2:58

along the RV and then eventually ends up in the

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PDA territory, and that's just a normal variant.

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So far as I've looked through these corn areas. I saw only

3:08

really that calcified plaque in the proximal ID.

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And so let's take a look on our CPR images.

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And assess this little closer.

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One thing to note when we're assessing stenosis. We

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always want to use the long axis images for stenosis assessment

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not short access images. And the

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reason for that is that our gold standard is cardiac catheterization and

3:29

calf all the assessment is done

3:32

via a long axis images. So we want to make sure it is be consistent

3:35

with that approach to assessing stenosis. So

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I'm gonna zoom in on this lesion here and

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you can see

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Like I talked about in some earlier videos. We're looking

3:45

at the amount of contrast that's moving past this lesion. You

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have a nice wide column of contrast passing

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this stenosis.

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So the degree of narrowing from this calcified plaque

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is very minimal.

3:59

I would say just eyeballing it somewhere in the you know,

4:02

20% range. Maybe at best.

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So again, the windowing really helps if you

4:08

have a more narrow window, you notice how that actually

4:11

makes the vessel calcification look a

4:14

little bit bigger. So you certainly do want to make sure to narrow window

4:17

nice and wide when your assistance calcified lesions.

4:21

So mild calcite plaque in the led the distal

4:24

vessel here.

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Looks good. I don't see any other disease.

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We've got a nice visualization of the diagonal branches which all look fine.

4:34

There it is. There's that diagonal branch. That looks good.

4:37

Overall just very minimal calcified black in this

4:40

patient and I think you know certainly she would

4:43

not need to have any further procedures.