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Additional resources for Computed Tomography and Magnetic Resonance of the Thorax
First Diagonal 5. Left main 10. Second Diagonal 8 14 15 11. Proximal LCX 12. First marginal 13. Mid-distal LCX 14. Posterolateral branch 15. Left PDA Figure 1-23 Coronary artery segmentation. RCA, right coronary artery; RPD, right posterior descending artery; AV, atrioventricular continuation of the right coronary artery; LCA, left coronary artery; LCX, left circumflex artery; CIRC, left circumflex artery; OM, obtuse marginal; PL; posterolateral; PD, posterior descending; LAD, left anterior descending; D1, first diagonal; D2, second diagonal; PDA, posterior descending artery.
The sinus node artery also arises from the proximal RCA in 60% of individuals (otherwise a left atrial branch of the LCX serves this function) and runs superiorly and posteriorly. In patients with a right dominant system, the distal RCA divides into the PDA and posterior LV branches. Dominance refers to which artery gives off a PDA to supply the posterior part of the heart. About 85% of patients are right dominant, 7% are codominant, and 8% are left dominant. The PDA courses along the inferior interventricular groove, providing septal perforators to supply the inferior septum (34).
Because the goal of myocardial perfusion assessment is to measure the gadolinium concentration in the blood and in the myocardium, single-shot images are acquired during each cardiac cycle to cover as much myocardium as possible (5 to 8 slices in short axis orientation) while maintaining high spatial and temporal resolution. Challenges with this technique are to reduce the acquisition time per image to avoid blurring and artifact related to cardiac motion. The use of parallel acquisition technology can help reduce 5636_Naidich_ch01_pp001-086 12/6/06 5:14 PM Page 29 Chapter 1: Heart 29 D Figure 1-29 Saturation recovery MR images at specific time points (A–C) during the first pass perfusion with gadolinium-containing contrast agent with corresponding time-intensity curves (D) of the ventricular cavity (1) and myocardium (2–4) demonstrate significant delay in perfusion of the inferoseptal wall (2) compared with the corresponding inferolateral (3) anterior (4) walls.