One-stop-shop cardiac CT: Calcium score, angiography, and myocardial perfusion

A 52-year-old man presented to the outpatient clinic with dyspnea on exertion and atypical angina. Cardiovascular risk factors were a history of smoking (25 pack years) and hypertension, and the pretest risk probability for coronary artery disease was 49%. The coronary artery calcium score (CACS) was 0; however, because of symptoms coronary CT angiography (CTA) was performed which showed a severe non-calcified lesion in the mid left anterior descending artery (LAD), Figure 1. Sequentially, an adenosine stress CT myocardial perfusion (CTP) was performed showing a reversible, anterolateral ([50% transmural) perfusion defect, Figure 2B. Invasive coronary angiography confirmed the significant stenosis in the mid-LAD (Figure 3), which was stented. Due to persisting symptoms single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) was performed, which showed dissolved ischemia anterolateral without new perfusion abnormalities, Figure 4.