Congenital abnormalities of the coronary arteries are an uncommon but important cause of chest pain and, in some cases of hemodynamically significant abnormalities, sudden cardiac death. For several decades, premorbid diagnosis of coronary artery anomalies has been made with conventional angiography. However, this imaging technique has limitations due to its projectional and invasive nature. The recent development of electrocardiographically (ECG)-gated multi-detector row computed tomography (CT) allows accurate and noninvasive depiction of coronary artery anomalies of origin, course, and termination. Multi-detector row CT is superior to conventional angiography in delineating the ostial origin and proximal path of an anomalous coronary artery. Familiarity with the CT appearances of various coronary artery anomalies and an understanding of the clinical significance of these anomalies are essential in making a correct diagnosis and planning patient treatment.

https://pubs.rsna.org/doi/pdf/10.1148/rg.262055068

Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation.

The purpose of the present study was to evaluate the role of 16 multislice computed tomography (MSCT) to identify the origin of anomalous coronary arteries and to confirm their anatomic course in relation to the great vessels. Accuracy of coronary artery disease (CAD) detection was a secondary aim and was tested with conventional angiograms (CA) serving as standard of reference. Two hundred and forty-two consecutive patients referred for noninvasive coronary CT imaging were reviewed for the study. Sixteen patients (6.6%) with anomalous coronary arteries were detected and included as the study group. MSCT and CA images were analyzed in a blinded fashion for accuracy of anomalous artery origin and path detection. Results were compared in a secondary consensus evaluation. Accuracy ratios to detect CAD with MSCT in all vessels were calculated. Coronary anomalies for all 16 patients were correctly displayed on MSCT. CA alone achieved correct identification of the abnormality in only 53% (P=0.016). Sensitivity and specificity of MSCT to detect significantly stenosed vessels was 90 and 92%. 16-MSCT is accurate to delineate abnormally branching coronary arteries and allows sufficiently accurate detection of obstructive coronary artery disease in distal branches. It should therefore be considered as a prime non-invasive imaging tool for suspected coronary anomalies.

Multislice CT imaging of anomalous coronary arteries.

The clinical relevance of coronary artery disease has considerably driven the recent development of radiologic tools for noninvasive cardiac imaging. Modern multidetector row computed tomographic (MDCT) systems combine high temporal and spatial resolution, electrocardiographic synchronization, and ease of use. In cardiac imaging, MDCT has not only replaced electron-beam CT, but also challenges competing methods such as magnetic resonance imaging, echocardiography, or even coronary catheterization. Noncontrast material-enhanced assessment of atherosclerotic plaques (CT calcium scoring) seems useful for the cardiac risk stratification in asymptomatic patients and monitoring of medical (statin) therapy. Contrast material-enhanced CT coronary angiography has become established as a valuable method for several clinical indications such as evaluation of coronary artery anomalies, bypass patency, or preoperative planning. Particularly, the high negative predictive value of a normal CT coronary angiogram allows reliable exclusion of coronary artery stenosis. Plaque characterization is another promising area of research in MDCT cardiac imaging. However, with current technology a reliable distinction between atheroma and fibroatheroma is impaired by restrictions in spatial resolution. Recent studies indicate that CT angiography may also be suited for other clinical applications such as triage of patients with acute coronary syndrome and inconclusive clinical presentation, patients with symptomatic chest pain, and intermediate risk profile or cardiac risk stratification in asymptomatic patients.

CT of coronary artery disease.

Early identification and evaluation of relatively frequent anomalous coronary anatomy is quite relevant because of the occurrence of sudden cardiac death or related symptoms of myocardial ischemia. Selective coronary angiography (CAG) is invasive, expensive and cannot always provide the required information adequately. Recently, non-invasive imaging techniques such as magnetic resonance imaging and multidetector-row computed tomography (MDCT) have been shown to provide a good anatomical view of the coronary artery tree. This study aims to demonstrate the value of 16-MDCT for evaluation of anomalous coronary anatomy. In 13 patients scanned using 16-MDCT, six different coronary anomalies were diagnosed [two absent left main, one single vessel left coronary artery (LCA), three LCA originating from the right (two with interarterial course), six right coronary artery originating from the left, one double left anterior descending (LAD)]. Mean diagnostic quality, recorded by two observers using a 5-point scale (1= non-diagnostic to 5= excellent diagnostic quality), resulted in a mean score of 3.73 (SD 1.19) without any non-diagnostic result. MDCT offers an accurate diagnostic modality to visualize the origin and course of anomalous coronary arteries by a three-dimensional display of anatomy. Shortcomings in CAG can be overcome by the use of contrast-enhanced MDCT.

Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT

Prevalence of typical angina and a major adverse cardiac event was significantly higher in patients with a high interarterial course of anomalous origins of the right coronary artery from the left coronary sinus than in those with a low course.

Anomalous origin of the right coronary artery from the left coronary sinus with an interarterial course: Subtypes and clinical importance

An aberrant origin of the left main coronary artery (LM) or left anterior descending coronary artery (LAD) from the right sinus of Valsalva is a rare anomaly that has been associated with myocardial ischemia and sudden cardiac death. Depending on the anatomic relationship of the anomalous vessel to the aorta and the pulmonary trunk, the anomaly can be classified into 4 common courses: posterior, interarterial, anterior, and septal course. Contrast-enhanced electron beam tomography (EBT) has been shown to permit classification of anomalous coronary arteries. We present 4 cases that illustrate the common variations of this anomaly. In all cases, EBT was performed using a C-150 XP EBT scanner (Imatron Inc). During inspiratory breathhold, 40 to 50 axial cross-sections of the heart were acquired triggered to the ECG at 40% of the R-R interval (100 ms acquisition time, slice thickness 3 mm, table feed 2 mm, intravenous injection of 160 mL contrast agent …

Anomalous Course of the Left Main or Left Anterior Descending Coronary Artery Originating From the Right Sinus of Valsalva

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Anomalous Course of the Left Main or Left Anterior Descending Coronary Artery Originating From the Right Sinus of Valsalva