Related Experiment Video
Updated: Feb 15, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography
Marysia S Tweet1, Nila J Akhtar2, Sharonne N Hayes1
11 Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, USA.
Insights
Coronary computed tomography angiography (CCTA) reveals key features of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome in young women. Abrupt luminal stenosis and intramural hematoma are most common, though CCTA requires further validation for SCAD diagnosis.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome (ACS), particularly in young women.
- The specific coronary computed tomography angiography (CCTA) features of SCAD have not been well-characterized.
- Understanding these CCTA findings is crucial for accurate diagnosis and management.
Purpose of the Study:
- To identify and describe the characteristic CCTA features of acute SCAD.
- To assess the prevalence of these features in patients diagnosed with SCAD.
- To evaluate the utility of CCTA in the diagnosis of SCAD.
Main Methods:
- Retrospective analysis of CCTA images from 14 patients (16 vessels) diagnosed with SCAD.
- Images were obtained within two days of invasive coronary angiography confirmation.
- Data collected from the "Virtual" Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry.
Main Results:
- The most prevalent CCTA features of SCAD were abrupt luminal stenosis (64%) and intramural hematoma (50%).
- Other observed features included tapered luminal stenosis (36%), dissection (14%), epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%).
- Myocardial hypoperfusion was present in 50% of patients in the affected coronary artery's distribution.
Conclusions:
- Key CCTA features for diagnosing SCAD include abrupt luminal stenosis and intramural hematoma.
- Intramural hematoma on CCTA can mimic noncalcified atherosclerotic plaque.
- Invasive coronary angiography remains essential for definitive SCAD diagnosis until CCTA sensitivity and specificity are better established.
Background:
The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed.
Methods:
The "Virtual" Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection.
Results:
Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery.
Conclusions:
We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:26Acute Coronary Syndrome V: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations