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Published on: February 10, 2012
High-resolution coronary MR angiography for evaluation of patients with anomalous coronary arteries: visualization of
David M Biko1, Claudia Chung, David M Hitt
1Department of Diagnostic Imaging, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA, bikod@email.chop.edu.
Insights
Magnetic resonance (MR) angiography accurately identifies the intramural segment of anomalous coronary arteries in children. This imaging technique aids in surgical planning and determining intervention for anomalous coronary arteries, potentially reducing sudden death risks.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Radiology
Background:
- Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare condition linked to sudden cardiac death.
- The inter-arterial course is particularly associated with sudden death.
- An intramural segment in anomalous right coronary arteries may correlate with increased symptoms and guide intervention decisions.
Purpose of the Study:
- To evaluate the accuracy of MR angiography in detecting intramural segments of anomalous coronary arteries.
- To establish imaging criteria for identifying intramural anomalous coronary arteries.
Main Methods:
- Retrospective review of MR angiography studies in children with anomalous coronary arteries.
- Radiologists assessed for specific criteria: small/slit-like ostium and proximal size reduction.
- Findings were correlated with intraoperative reports.
Main Results:
- MR angiography correctly identified intramural segments in 12 out of 14 patients (86%).
- MR angiography correctly identified non-intramural segments in 2 out of 14 patients (14%).
- The technique demonstrated high accuracy (P=.01) in differentiating intramural from non-intramural courses.
Conclusions:
- MR angiography can reliably detect intramural segments in anomalous coronary arteries in children.
- Imaging criteria include a small ostium and proximal size decrease.
- Accurate identification aids surgical planning and intervention decisions for these anomalies.
Background:
Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare coronary anomaly associated with sudden death. The inter-arterial course is most closely associated with sudden death, but it has been suggested that the presence of an intramural segment of a right anomalous coronary is associated with more symptoms and therefore may be an important criterion for intervention in these patients.
Objective:
To demonstrate that MR angiography can accurately determine the presence or absence of an intramural segment in an anomalous coronary artery.
Materials And Methods:
All studies of children who underwent MR angiography for the evaluation of an anomalous coronary artery were retrospectively reviewed by two pediatric radiologists in consensus. Criteria for an intramural anomalous coronary artery were the presence of a small or slit-like ostium and the relative smaller size of the proximal intramural portion of the coronary artery in relation to the more distal epicardial coronary artery. The anomalous coronary artery was classified as not intramural if these two findings were absent. These findings were correlated with operative reports confirming the presence or absence of an intramural segment.
Results:
Twelve patients (86%) met MR angiography criteria for the presence of an intramural course. Only 2 patients (14%) met MR angiography criteria for a non-intramural course. When correlating with intraoperative findings, MR angiography was successful in distinguishing between intramural and non-intramural anomalous coronary arteries in all cases (P = 0.01).
Conclusion:
MR angiography may be able to reliably identify the intramural segment of an anomalous coronary artery in older children using the imaging criteria of a small or slit-like ostium and relative decrease in size of the proximal portion of the anomalous coronary artery compared to the distal portion of the anomalous coronary artery. Determining the presence of the intramural segment may help with surgical planning and may be an important criterion for the determination of intervention in patients with inter-arterial anomalous right coronary arteries.
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