case_images: PMC10229782_01
case_images: Invasive coronary angiography. CX, circumflex coronary artery; LAD, left anterior descending coronary artery.
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case_images: F1
case_images: Invasive coronary angiography showed severe stenosis at the distal portion of the circumflex coronary artery and diffuse sclerosis of the left anterior descending coronary artery. Intravascular ultrasonography showed a Stanford scale IV score (Figure 1).
case_images: Routine magnetic resonance (MR) cine images in the four-chamber view (panel A) show thickened and hyperintense vessels (arrow) at the right atrioventricular groove. The high resolution T2-weighted and fat saturated sequence (panel B) at the same level confirms thickened walls of the right coronary artery with hyperintense epicardial fat tissue due to edema. The corresponding specimen slice confirmed significant epicardial coronary vessel wall thickening, particularly in the right coronary artery (RCA, arrow).
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case_images: PMC10229782_01_fcvm-10-1123212-g002.jpg
case_images: F2
case_images: T; Siemens, Erlangen, Germany) and showed mild concentric hypertrophy of the left ventricle and moderately reduced left ventricular function. T2-weighted short-tau inversion recovery (STIR) sequence images showed widespread sub-epicardial hyperintensity of the myocardial segments (signal intensity ratio to skeletal muscle > 2) along the course of the coronary arteries (Figure 2). T2 mapping sequences showed an elevated value of 57 ms, and the myocardial native T1 values and extracellular volume percentage were significantly elevated (1170 ms and 41%, respectively).
case_images: The curved multiplanar reformatting view (panel A) of the right coronary artery with the 3 short-axis vessel views using high resolution magnetic resonance (MR) coronary imaging with additional fat epicardial suppression (whole-heart imaging) confirms wall thickening along the course of the right coronary artery (arrows) and inflammatory abnormalities of the epicardial fat surrounding the vessel (arrowheads). The detailed anatomical view of the right atrioventricular groove (panel B) matches the MR coronary findings.
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case_images: PMC10229782_01_fcvm-10-1123212-g003.jpg
case_images: F3
case_images: The "whole-heart" sequence (navigator-gated, vector ECG-triggered, fat-suppressed T2-weighted 3-dimensional gradient-echo inversion recovery) demonstrated widespread hyper-enhancement of epicardial fat along the course of the thickened main coronary artery walls (Figure 3) At rest, there were no sub-endocardial defects in the anteroseptal and basal infero-septal segments.