Coronary CTA with High-Risk Plaque (HRP)
68-year-old male with chest pain, prior non-ST-segment elevation myocardial infarction (NSTEMI).
Figure A. Curved planar reconstruction (CPR) of left main and left anterior descending artery (LAD) coronary arteries. There is prominent noncalcified plaque with spotty calcification in the left main coronary artery (arrowheads). The entirety of the vessel is larger than normal, resulting in only mild narrowing of the flow lumen (positive remodeling).
Figure B. Orthogonal cross section through the left main plaque in figure A shows spotty calcification (arrow) and relatively preserved flow lumen (arrowhead). The vessel itself is > 1.5x larger than the adjacent normal arterial segment (white line).
Patient demographics:
Height: 180 cm
Weight: 91 kg
CTA injection parameters:
Scan time: 5 sec
Diagnostic (“trigger”) delay: 6 sec
Bolus tracking: aortic root
Tube energy: 120 kVp
Contrast concentration: 370 mgI/mL
Contrast volume: 65 mL
Contrast flow rate: 5 mL/sec
Saline flush volume: 30 mL
Saline flow rate: 5 mL/sec
Figure C. CT fractional flow reserve (CT-FFR) diagram for the coronary system. Despite the narrowing of the flow lumen, the HRP left main lesion is not significant by CT-FFR (arrow, >0.93). FFR-CT below 0.75 implies high likelihood of significant flow reduction.
High-risk plaque has higher incidence of future acute coronary syndrome, as well as higher lesion-specific ischemia. According to
Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0, HRP is defined by 2 or more of the following lesion
characteristics¹:
- Positive remodeling
- Spotty intra-plaque calcification
- Lipid-rich plaque
- Napkin-ring sign
Reference: 1. Cury RC, Leipsic J, Abbara S, et al. J Am Coll Cardiol Img. 2022;15(11):1974-2001.
All images, protocols, and outcomes are courtesy of Dr. Richard Hallett, Northwest Radiology, Indianapolis, IN.
Individual results may vary.
Most Recent Cases
IMPORTANT SAFETY INFORMATION | INDICATIONS AND USAGE
EmpowerCTA®+ Injector System
Caution: Federal law restricts this device to sale by or on the order of a physician.
INDICATIONS:
The EmpowerCTA®+ Injector System is indicated for the vascular administration of contrast and flushing media in conjunction with computed tomography (CT) scanning of the body with an optional interface to a CT scanner and an optional calculator for glomerular filtration rate (GFR).
INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION
EmpowerCTA®+ Injector System
Caution: Federal law restricts this device to sale by or on the order of a physician.
INDICATIONS:
The EmpowerCTA®+ Injector System is indicated for the vascular administration of contrast and flushing media in conjunction with computed tomography (CT) scanning of the body with an optional interface to a CT scanner and an optional calculator for glomerular filtration rate (GFR).
Protocols have been independently developed and are not intended as medical advice. Bracco and Bracco Injeneering S.A. shall not be responsible for any physicians’ reliance on these or any other products.
CONTRAINDICATIONS:
The EmpowerCTA®+ Injector System is not intended for use as a long-term infusion pump, nor is it intended to be used to inject any agents other than contrast or flushing media. Do not attempt to use the injector for any other purpose (such as chemotherapy or drug infusion). The EmpowerCTA+ Injector System should not be used to inject substances into nonvascular body cavities. Any applications of the EmpowerCTA+ Injector System other than those described in its Operator Manual are inappropriate and should not be attempted.
Not all products are available in all global markets.
EmpowerCTA+ is distributed by Bracco Diagnostics Inc.; 510 Carnegie Center Drive, Suite 300, Princeton, NJ 08540 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Scientific Information: 1-800-257-5181 (Option 2); EmpowerCTA+ Email: empowerinfo@diag.bracco.com; Website: https://smartinject.com/ct-solutions/
EmpowerCTA+ is manufactured by Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. https://www.bracco.com/
EmpowerMR® Injector System
Caution: Federal law restricts this device to sale by or on the order of a physician.
INDICATIONS:
The EmpowerMR® Injector System is indicated for vascular administration of contrast media and flushing media in conjunction with magnetic resonance imaging (MRI).
Protocols have been independently developed and are not intended as medical advice, and Bracco shall not be responsible for any physicians' reliance on these or any other protocols.
Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.
Not all products are available in all global markets.
EmpowerMR is distributed by Bracco Diagnostics Inc.; 510 Carnegie Center Drive, Suite 300, Princeton, NJ 08540 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Scientific Information: 1-800-257-5181 (Option 2); Website: https://smartinject.com/mr-solutions/
EmpowerMR is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46 CH – 1004 Lausanne, Switzerland. https://www.bracco.com/
NEXO® Contrast Management System
Intended Use:
The NEXO® Contrast Management System is a server-based application intended to be used as a data management and visualization system. The NEXO Contrast Management System can read, store, share, compare/relate, as well as graphically display data and injection programs coming from RIS, PACS, and multiple enabled EmpowerCTA® Injector Systems. This device provides users with record lists, graphics, and reports about data and performances.
This device is intended for retrospective and statistical data management and visualization. It is not intended for real-time data visualization, diagnostic applications, or for any other use for which the device is not indicated. This device is only to be operated by and under quasi-continuous supervision of qualified and trained staff in an appropriately licensed healthcare facility.
The NEXO Contrast Management System is compatible with the EmpowerCTA Injector System version 8.0, and EmpowerCTA®+ Injector System version 10.0 and higher.
Not all products are available in all global markets.
NEXO is distributed by Bracco Diagnostics Inc.; 510 Carnegie Center Drive, Suite 300, Princeton, NJ 08540 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; NEXO Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO questions: Nexo.Answers@diag.bracco.com; NEXO U.S. Technical Service and Support: Phone: 888-670-7701; Fax: 609-514-2448; NEXO Email: customer.support@acistmedical.com; Website: https://smartinject.com/digital-solutions
NEXO is manufactured by ACIST Medical Systems, 7905 Full Road, Eden Prairie, MN 55344 USA.
About Bracco Injeneering S.A.
Bracco Injeneering S.A., located in Lausanne, Switzerland, is the most recently added Business Unit of Bracco Imaging. Bracco Injeneering is committed to developing the best-in-class, integrated injection solutions with a strong heritage in research and innovation. It provides quality solutions for state-of-the-art radiology centers, offering proven injection technology, built on Bracco Imaging’s expertise.
Thanks to this strengthened product portfolio, including the EmpowerCTA®+ Injector System and EmpowerMR Injector System Bracco Imaging will be able to focus on constant innovation, not only for devices but also for software development and data management.
EmpowerCTA, EmpowerMR, NEXO, and IRiSMR are registered trademarks of ACIST Medical Systems, Inc.
FastLoad is a trademark of ACIST Medical Systems, Inc.
ulricheasyINJECT Max 3™
ulricheasyINJECT Max 3 is manufactured by ulrich GmbH & Co. KG.
ulrich medical is a registered trademark of ulrich GmbH & Co. KG.
ulricheasyINJECT Max 3 is a trademark of ulrich GmbH & Co. KG.
ulricheasyINJECT Max 3 is distributed by Bracco Diagnostics Inc.; 510 Carnegie Center Drive,
Suite 300; Princeton, NJ 08540 USA; Phone: (800) 631-5245; Fax: (609) 514-2424;
Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Scientific Information: 1-800-257-5181
(Option 2); Website: https://smartinject.com
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