Congenital coronary anomalies in adults: comparison of anatomic course visualization by catheter angiography and
Esat Memisoglu1, Gultekin Hobikoglu, M Savas Tepe
1Test Cardiovascular Imaging, Istanbul, Turkey. memisoei@slu.edu
Insights
Electron beam computed tomography (EBCT) coronary angiography accurately identifies anomalous coronary arteries, comparing favorably with X-ray catheter angiography (CAG). EBCT offers valuable insights into the precise anatomic course of these anomalies.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Anatomic Pathology
Background:
- Accurate visualization of anomalous coronary arteries is crucial for clinical management.
- Conventional X-ray catheter angiography (CAG) is invasive and may have limitations in depicting complex coronary anatomy.
- Electron beam computed tomography (EBCT) offers a noninvasive approach for coronary angiography.
Purpose of the Study:
- To compare the anatomic course of anomalous coronary arteries using axial and 3D volume-rendered EBCT angiography versus CAG.
- To evaluate the diagnostic performance of EBCT coronary angiography in identifying coronary anomalies.
Main Methods:
- A blinded study comparing EBCT coronary angiography with prior CAG in patients with and without coronary anomalies.
- Acquisition of 40-50 EKG-triggered axial slices with 3D volume rendering during contrast injection.
- Evaluation of axial source images and 3D reconstructions for presence, type, and course of coronary anomalies.
Main Results:
- Both EBCT and CAG successfully identified all normal and anomalous coronary arteries in all subjects.
- Identified anomalies included single coronary artery, malposition of coronary origins, and separate ostia.
- Consensus reading favored EBCT interpretation over CAG in cases of discrepancy regarding the anomalous vessel course.
Conclusions:
- Noninvasive EBCT coronary angiography demonstrates comparable efficacy to CAG in identifying anomalous coronary arteries.
- EBCT provides valuable confirmatory evaluation of the precise anatomic relationships of coronary anomalies to the heart and great vessels.
- EBCT angiography is a promising tool for the assessment of coronary artery anomalies.
Abstract:
The objective of this study was to compare the anatomic course of anomalous coronary arteries by axial and three-dimensional volume-rendered electron beam computed tomography (EBCT) angiography and X-ray catheter angiography (CAG). We performed a blinded study where patients who previously underwent CAG with (n = 14) and without (n = 14; age- and gender-matched controls) anomalous coronary anatomy were studied with EBCT coronary angiography. Forty to 50 EKG-triggered 3 mm overlapping axial slices were acquired with 2 mm table movement within one breath hold during the i.v. injection of 140 cc of nonionic iodinated contrast (4 ml/sec). The axial source images and volume-rendered three-dimensional reconstructions were evaluated for the presence, type, and course of coronary anomalies and the results were compared to those of CAG. All normal and anomalous coronary arteries were identified by both modalities in all subjects. Identified anomalies include single coronary artery (n = 3), left-sided right coronary artery (n = 3), right-sided left main coronary artery (n = 3), anterior descending coronary artery (n = 2), circumflex coronary artery (n = 2), and separate left-sided ostia for left anterior descending and circumflex coronary arteries (n = 1). In five cases, there was discrepancy in the course of the anomalous vessels between the two modalities. Consensus reading among cardiologist and radiologists favored the interpretation of EBCT over catheter angiography. Noninvasive EBCT coronary angiography compares well with CAG in identifying anomalous coronary arteries and may provide confirmatory evaluation of their precise anatomic relationships to the heart and great vessels.
More Related Videos
10:16Retrograde Perfusion and Filling of Mouse Coronary Vasculature as Preparation for Micro Computed Tomography Imaging
Published on: February 10, 2012
06:59Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:24Cardiac Catheterization III: Left Heart Catheterization
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...