Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity-A Primer for Cardiac Imagers

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Spontaneous coronary artery dissection (SCAD) is a significant cause of myocardial infarction in younger women.
• Diagnosing SCAD is challenging, and invasive coronary angiography carries risks for these patients.
• Current diagnostic criteria and accuracy for SCAD using coronary CT angiography (CCTA) are not well-established.

Purpose of the Study:

• To review the role of CCTA in diagnosing SCAD.
• To explore the utility of multimodality imaging in improving SCAD diagnosis and management.

Main Methods:

• Review of current literature on SCAD diagnosis.
• Discussion of CCTA's capabilities and limitations in identifying SCAD.
• Exploration of complementary noninvasive imaging techniques.

Main Results:

• CCTA can noninvasively evaluate coronary arteries, offering a low-radiation alternative to angiography.
• SCAD may present subtly on CCTA, potentially leading to missed diagnoses, especially in distal vessels.
• Multimodality imaging approaches may enhance diagnostic accuracy for SCAD.

Conclusions:

• CCTA holds potential for SCAD diagnosis, particularly in hemodynamically stable patients.
• Standardized diagnostic criteria for CCTA in SCAD are needed.
• Integrating multimodality imaging can improve diagnostic yield, guide treatment, and facilitate surveillance for SCAD.