Atypical pain with positive CTA and normal MPI

Case presentation:

• Female.
• 51 y.o.
• Heavy family history of CAD, no other known risk factors.
• Episodes of atypical chest discomfort. - Positive exercise test.
• Submitted for CT angiography (CTA), reported as:Severe proximal LAD stenosis, no other lesions, Ca score >1000.

Teaching points:

• CTA is sensitive for detecting CAD, however the technique has limited value in predicting the degree of stenosis.
• Especially in the presence of arterial calcifications, it is sometimes difficult to assess the characteristics of a coronary lesion by CTA.
• Calcium score >300 is associated with poor accuracy of CTA results (incomplete evaluation of coronary tree).
• Myocardial perfusion has powerful prognostic value and is not affected by calcium score.