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Contrast-enhanced 64-slice computed tomography in detection and evaluation of anomalous coronary arteries
Mustafa Karaca1, Ata Kirilmaz, Güray Oncel
1Department of Cardiology, Sifa Medical Center, Izmir, Turkey.
Insights
Contrast-enhanced 64-slice CT effectively evaluates anomalous coronary arteries (ACA), offering superior visualization of their origin and course compared to invasive coronary angiography. This non-invasive method is recommended as a first-line diagnostic tool for ACA.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Anomalous coronary artery (ACA) presents diagnostic challenges due to subtle symptoms and is linked to sudden cardiac death.
- ACA is often incidentally found during invasive coronary angiography (ICA).
- Conventional CT lacks the detail for evaluating coronary arteries in a moving heart.
Purpose of the Study:
- To assess the diagnostic validity of contrast-enhanced 64-slice CT for evaluating anomalous coronary arteries (ACA).
- To compare the efficacy of 64-slice CT with ICA in identifying ACA.
- To establish 64-slice CT as a potential first-line diagnostic tool for ACA.
Main Methods:
- Evaluated 59 patients with suspected or diagnosed anomalous coronary arteries (ACA) using contrast-enhanced 64-slice CT.
- Compared CT findings with results from invasive coronary angiography (ICA) in a cohort of 7,574 patients.
- Assessed image quality and diagnostic accuracy of 64-slice CT in visualizing ACA anatomy.
Main Results:
- Contrast-enhanced 64-slice CT visualized the entire abnormal coronary tree with high diagnostic image quality in 59 patients.
- ACA was detected in 0.7% of patients undergoing ICA and 1.2% of patients with vague symptoms evaluated by CT.
- 64-slice CT successfully identified the origin and course of ACA, including stenosis, in most evaluated patients.
Conclusions:
- Contrast-enhanced 64-slice CT is a highly effective non-invasive tool for evaluating anomalous coronary arteries (ACA).
- 64-slice CT offers superior visualization of ACA compared to ICA.
- The study recommends contrast-enhanced 64-slice CT as the preferred first-line diagnostic approach for ACA.
Abstract:
Anomalous coronary artery (ACA) has either an unusual origin or different anatomical course and is associated with sudden cardiac death. The absence or nonspecific symptoms of ACA make its diagnosis difficult. Mostly, ACA is diagnosed coincidentally during invasive coronary angiogram (ICA). A conventional computed tomography (CT) cannot provide detailed images of coronary arteries of the moving heart, but 64-slice CT, with its short acquisition time, can provide detailed anatomy of coronary arteries non-invasively. In this study, we assessed the validity of contrast-enhanced 64-slice CT in the evaluation of ACA. ICA was performed in 7,574 patients for the diagnosis or evaluation of occlusive coronary artery disease and detected coronary anomalies in 56 patients (0.7%). We then performed 64-slice CT in 53 patients out of the 56 patients with demonstrated or suspected coronary anomaly, showing the origin and the course of the ACA along with stenosis, except for one patient who could not be evaluated due to image distortion artifacts. Contrast-enhanced 64-slice CT was also performed in 374 patients with vague signs and symptoms, detecting coronary anomalies in 7 patients (1.2%). Thus, in the total of 59 patients undergone 64-slice CT, we were able to visualize the entire abnormal coronary tree with a high diagnostic image quality. This is the first study to demonstrate the utility of 64-slice CT in a large series of ACA. Contrast-enhanced 64-slice CT is superior to ICA to identify the presence and course of ACA and should be the first line diagnostic tool in the evaluation of ACA.
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