Anomalous coronary arteries: depiction at dual-source computed tomographic coronary angiography
Hai Xu1, Yinsu Zhu, Xiaomei Zhu
1Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
Dual-source computed tomographic coronary angiography (DSCT-CA) effectively identifies coronary artery anomalies. This noninvasive imaging tool provides detailed 3D anatomy, aiding diagnosis in patients with suspected coronary disease.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Anatomical Pathology
Background:
- Coronary artery anomalies can be challenging to diagnose using conventional methods.
- Accurate imaging is crucial for understanding the clinical implications of these anomalies.
Purpose of the Study:
- To define the imaging characteristics of coronary artery anomalies using dual-source computed tomographic coronary angiography (DSCT-CA).
- To evaluate DSCT-CA as a diagnostic tool for coronary anomalies.
Main Methods:
- Retrospective review of 12,145 patients who underwent DSCT-CA.
- Analysis of imaging data using multiplanar reformation, maximum-intensity projection, and volume rendering.
- Consensus assessment by two cardiovascular radiologists to identify and characterize coronary anomalies.
Main Results:
- 124 patients (1.02%) had coronary anomalies, including anomalous origin of coronary arteries (n=69) and coronary artery fistulas (n=50).
- Specific anomalies identified included abnormal origins of the right coronary artery, left circumflex artery, and left main artery.
- DSCT-CA also identified single coronary arteries and associated congenital heart defects.
Conclusions:
- DSCT-CA is a reliable noninvasive method for delineating coronary artery anomalies.
- The technique provides detailed 3D anatomical information, superior to invasive angiography in some cases.
- DSCT-CA is valuable in the appropriate clinical setting for diagnosing coronary anomalies.
Objective:
To retrospectively determine the imaging features of coronary artery anomalies depicted at dual-source computed tomographic coronary angiography (DSCT-CA).
Methods:
We reviewed the case histories of 12,145 patients with suspected coronary arterial disease who underwent DSCT-CA at our institution. Multiplanar reformation, maximum-intensity projection, and volume-rendered imaging were performed on an offline workstation. Each study was assessed retrospectively for the origin and course of the anomalous coronary artery by a minimum of 2 cardiovascular radiologists; decisions were made in consensus.
Results:
There were 124 (1.02%) patients with coronary anomalies. Fifty-one patients demonstrated an anomalous origin of the right coronary artery from the left sinus of Valsalva or the left main artery. An anomalous origin of a left circumflex artery from the right sinus of Valsalva or the right coronary artery was depicted in 17 patients. An anomalous origin of a left main artery from the right sinus of Valsalva was depicted in 1 patient. A single coronary artery was shown in 4 patients, and congenital transposition of the great arteries was associated with this anomaly in 1 patient. In the remaining 50 patients, coronary artery fistulas were identified. Eight patients were referred after an equivocal conventional coronary angiogram.
Conclusions:
DSCT-CA is a reliable noninvasive tool that allows accurate delineation of coronary arterial anomalies in an appropriate clinical setting and provides detailed 3-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography.
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