Multimodality Imaging in Coronary Artery Anomalies: Current Standards and Future Perspectives

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Coronary artery anomalies (CAA) are rare congenital heart diseases, often underdiagnosed.
• CAA can range from benign to life-threatening, potentially causing sudden cardiac death.
• Advancements in imaging have increased CAA visibility and the need for accurate diagnosis.

Purpose of the Study:

• To review and integrate non-invasive imaging modalities for diagnosing coronary artery anomalies.
• To highlight the complementary roles of various imaging techniques in assessing CAA.
• To illustrate the clinical significance of CAA through case examples.

Main Methods:

• Computed tomography (CT) with contrast is the gold standard for anatomical depiction.
• Echocardiography offers unique signs for specific CAA, especially in pediatric and pregnant patients.
• Cardiac magnetic resonance (CMR) assesses hemodynamic effects and tissue changes.
• Nuclear imaging (SPECT, PET) evaluates myocardial perfusion and ischemia.
• Virtual Reality (VR) and Augmented Reality (AR) are emerging technologies.

Main Results:

• CT provides detailed origin, course, and termination of coronary arteries, identifying high-risk variants.
• Echocardiography reveals specific signs like the "crossed aorta sign," "bleb sign," and "Christmas tree sign."
• CMR is valuable for analyzing functional consequences and myocardial tissue changes (fibrosis, edema).
• Nuclear imaging quantifies perfusion deficits and ischemia, guiding surgical decisions.
• Integrated imaging approaches enhance diagnostic accuracy and clinical management of CAA.

Conclusions:

• Non-invasive imaging methods are complementary in diagnosing and assessing the physiological impact of CAA.
• Accurate diagnosis and risk stratification are essential for preventing severe complications.
• Further research into VR/AR applications in CAA imaging is warranted.