Cardiovasc Imaging Asia.  2017 Jul;1(3):205-207. 10.22468/cvia.2017.00010.

Napkin-Ring Sign on Coronary Computed Tomography Angiography-Tiered Enhancement of Coronary Lumen and Plaque

• Utsunomiya D
• Hokimoto S
• Kanemaru Y
• Oda S
• Nakaura T
• Kidoh M
• Yuki H
• Hirata K
• Yamashita Y

• KMID: 2524847
• DOI: http://doi.org/10.22468/cvia.2017.00010

Abstract

We present the case of an 85-year-old man showing the “napkin-ring sign” tiered enhancement pattern on dual-phase coronary CT angiography using a 320-row multidetector CT. This has not been previously reported. In the first-phase scan, only the coronary arterial lumen was opacified. In the second-phase scan, not only the coronary arterial lumen but also the plaque margin was clearly enhanced (the “napkin-ring sign”). We considered that the tiered enhancement pattern might reflect the pathology of the “napkin-ring sign” which includes a necrotic core in the center of a plaque surrounded by fibrosis with proliferation of microangiotextures.

Keyword

Coronary artery disease; Plaque; Atherosclerotic; Multidetector computed tomography