Case: Ruling out Coronary Artery disease with 0.69 mSv

History
A 68-year-old patient with atypical chest pain and known year-long arterial hypertension presented at our department in order to rule out coronary artery disease. Ultrasound showed concentric LV hypertrophy and aortic valve stenosis grade 1.
Resting heart rate was 50 bpm and no beta-blockers were injected.

Diagnosis
Coronary CT angiography using the prospectively ECG-gated FLASH spiral was performed utilizing only 0.69 mSv radiation dose.
We found mild concentric LV hypertrophy and minor calcifications of the aortic valve. There was no sign of macroangiopathic arteriosclerotic changes in the main coronary arteries and their major branches. Coronary artery disease could be ruled out in this patient.

Comments
Coronary CT angiography using 100 kV tube potential and the FLASH spiral acquisition mode allowed ruling out coronary artery disease in this normal-sized adult patient (185 cm/86 kg) with a DLP of 49 in only 0.29 seconds scan time without the use of beta blockers. The smallest myocardial branches of the RCA, LAD and LCX could be visualized underlining best image quality at lowest dose values.

Authors: Ralf W. Bauer, MD, J. Matthias Kerl, MD and Thomas J. Vogl, MD