Cardiology Research and Practice 5 RV LV (a) RA (c) LV LA ∗ LCx LAD ∗ ∗ Ao D1 LAD RV (b) (d) Figure 3: 61-year-old male with aggressive large B-cell lymphoma developed chest pain after the ﬁrst cycle of chemotherapy. Electrocardiogram and cardiac enzyme measurements are consistent with NSTEMI. Echocardiography demonstrated a decrease in left ventricular ejection fraction from a normal baseline to 40%. Due to postchemotherapy thrombocytopenia and leucopenia, an invasive coronary angiogram could not be obtained. Based on the coronary CT angiogram results, further chemotherapy was placed on hold. Invasive coronary angiography was performed after recovery of blood counts, followed by coronary artery bypass grafting. Two weeks later, the patient restarted chemotherapy. (a) Curved reformat view of the right coronary artery shows scattered calciﬁc and noncalciﬁed atherosclerotic plaque (white arrowheads) with possible occlusion (arrow) near the junction of the mid and distal segments. The conus branch origin (black arrowhead) is identiﬁed. (b) Curved reformat view of the left anterior descending artery (LAD) shows calciﬁc and noncalciﬁed atherosclerotic plaque (white arrowheads) in the proximal LAD, with focal near occlusion (arrow) of the LAD at the origin of the ﬁrst diagonal (D1). Also noted is a mixed ostial left main artery plaque (asterisk). (c) Curved reformat view of the circumﬂex coronary artery (LCx) and proximal LAD shows calciﬁc and noncalciﬁed atherosclerotic plaque (arrowheads) in the proximal segments of both vessels. The LCx appears occluded at the junction of the proximal and middle segments (arrow). The ostial left main artery plaque in this projection appears noncalciﬁed and signiﬁcantly stenotic (asterisk). LA = left atrium. LV = left ventricle. RA = right atrium. RV = right ventricle. Ao = Aortic root. (d) Invasive angiogram demonstrating same ﬁndings with good correlation. The left main coronary is signiﬁcantly stenosed (asterisk). The left anterior descending artery shows multiple high grade stenoses (thin arrow) and the left circumﬂex artery is occluded (thick arrow). therapies diﬃcult, if not contraindicated. Cancer patients receiving chemotherapy and experiencing bone marrow suppression are at higher risk of procedural complications should they undergo ICA routinely. In other instances, postoperative status, ongoing infections, or radiation therapy may also preclude an invasive approach. In fact, a large majority of our patients had at least one relative contraindi- cation to ICA, and as such would have been less likely to be fully assessed without CCTA. This often leads to the use of noninvasive stress imaging, traditionally echocardiography and nuclear imaging for a functional assessment of the coronaries. However, neither technique is able to show nonobstructive CAD, nor are they free of false positives [8] (which could lead to unnecessary ICA [9]) and false negatives (which could fail to correctly identify cancer patients with signiﬁcant CAD). CCTA also allowed the accurate diagnosis of CIC, which has important implications in ongoing cancer care. Current guidelines for the diagnosis of CIC recommend a coronary angiogram to exclude the presence of signiﬁcant CAD. The ACC/AHA guidelines for the diagnosis and management of heart failure updated in 2009 [2] recognize the use of noninvasive imaging for detection of ischemia in patients presenting with heart failure, if revascularization is contem- plated, with the caveat that stress testing may not reliably distinguish between ischemic and nonischemic etiologies.