European Radiology

, Volume 14, Issue 12, pp 2172–2181 | Cite as

Multislice CT imaging of anomalous coronary arteries

  • Heshui Shi
  • Andrik J. Aschoff
  • Hans-Juergen Brambs
  • Martin H. K. HoffmannEmail author


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.


Computed tomography Angiography Coronary vessels Abnormalities Coronary vessels CT Heart abnormalities 


  1. 1.
    Angelini P, Velasco JA, Flamm S (2002) Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 105:2449–2454CrossRefPubMedGoogle Scholar
  2. 2.
    Bunce NH, Lorenz CH, Keegan J et al (2003) Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography. Radiology 227:201–208PubMedGoogle Scholar
  3. 3.
    Engel H, Torres C, Page H (1975) Major variations in anatomical origin of the coronary arteries: angiographic observations in 4,250 patients without associated congenital heart disease. Cathet Cardiovasc Diagn 1:157–169PubMedGoogle Scholar
  4. 4.
    McConnell MV, Ganz P, Selwyn AP, Li W, Edelman RR, Manning WJ (1995) Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 92:3158–3162PubMedGoogle Scholar
  5. 5.
    Rodenwaldt J (2003) Multislice computed tomography of the coronary arteries. Eur Radiol 13:748–757PubMedGoogle Scholar
  6. 6.
    Pannu HK, Flohr TG, Corl FM, Fishman EK (2003) Current concepts in multi-detector row ct evaluation of the coronary arteries: principles, techniques, and anatomy. RadioGraphics 23:111S–112SGoogle Scholar
  7. 7.
    Angelini P, Villason S, Chan AV et al (1999) Normal and anomalous coronary arteries in humans. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  8. 8.
    Virmani R, Burke AP, Farb A (2000) The pathology of sudden cardiac death in athletes. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  9. 9.
    Kopp A, Kuttner A, Trabold T, Heuschmid M, Schroder S, Claussen C (2003) MDCT: cardiology indications. Eur Radiol 13[Suppl 5]:M102–M115Google Scholar
  10. 10.
    Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054CrossRefPubMedGoogle Scholar
  11. 11.
    Hoffmann MH, Shi H, Manzke R (2004) Non-invasive coronary angiography with 16 multi-detector row computed tomography: the effect of heart rate. Radiology DOI 10.1148/radiol.2341031408Google Scholar
  12. 12.
    Hoffmann MHK, Shi H, Schmid FT, Gelman H, Brambs H-J, Aschoff AJ (2004) Noninvasive coronary imaging with MDCT in comparison to invasive conventional coronary angiography: a fast-developing technology. Am J Roentgenol 182:601–608Google Scholar
  13. 13.
    Taylor AM, Thorne SA, Rubens MB et al (2000) Coronary artery imaging in grown up congenital heart disease: complementary role of magnetic resonance and X-ray coronary angiography. Circulation 101:1670–1678PubMedGoogle Scholar
  14. 14.
    Lipton M, Bogaert J, Boxt L, Reba R (2002) Imaging of ischemic heart disease. Eur Radiol 12:1061–1080CrossRefPubMedGoogle Scholar
  15. 15.
    Chaitman B, Lesperance J, Saltiel J, Bourassa M (1976) Clinical, angiographic, and hemodynamic findings in patients with anomalous origin of the coronary arteries. Circulation 53:122–131PubMedGoogle Scholar
  16. 16.
    Levin D, Fellows K, Abrams H (1978) Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation 58:25–34PubMedGoogle Scholar
  17. 17.
    Serota H, Barth C, Seuc C, Vandormael M, Aguirre F, Kern M (1990) Rapid identification of the course of anomalous coronary arteries in adults: the “dot and eye” method. Am J Cardiol 65:891–898CrossRefPubMedGoogle Scholar
  18. 18.
    Post JC, van Rossum AC, Bronzwaer JGF et al (1995) Magnetic resonance angiography of anomalous coronary arteries: a new gold standard for delineating the proximal course? Circulation 92:3163–3171PubMedGoogle Scholar
  19. 19.
    Niino T, Shiono M, Inoue T, Hata M, Sezai A, Negishi N (2003) A reoperation of Adult-Type Bland-White-Garland syndrome. Ann Thorac Surg 76:267–269CrossRefPubMedGoogle Scholar
  20. 20.
    Gerber TC, Kuzo RS, Safford RE et al (2002) Computed tomographic imaging of anomalous coronary arteries * response. Circulation 106:67eCrossRefGoogle Scholar
  21. 21.
    Herzog C, Abolmaali N, Balzer JO et al (2002) Heart-rate-adapted image reconstruction in multidetector-row cardiac CT: influence of physiological and technical prerequisite on image quality. Eur Radiol 12:2670–2678PubMedGoogle Scholar
  22. 22.
    Ropers D, Gehling G, Pohle K et al (2002) Anomalous course of the left main or left anterior descending coronary artery originating from the right sinus of Valsalva: identification of four common variations by electron beam tomography. Circulation 105:42e–43eCrossRefGoogle Scholar
  23. 23.
    Frommelt P, Frommelt M, Tweddell J, Jaquiss R (2003) Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol 42:148–154CrossRefPubMedGoogle Scholar
  24. 24.
    Schiele TM, Weber C, Rieber J et al (2002) Septal course of the left main coronary artery originating from the right sinus of Valsalva. Circulation 105:1511–1512CrossRefPubMedGoogle Scholar
  25. 25.
    Marano R, Storto M, Maddestra N, Bonomo L (2004) Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography. Eur Radiol 14:1353–1362Google Scholar
  26. 26.
    Flohr T, Bruder H, Stierstorfer K, Simon J, Schaller S, Ohnesorge B (2002) New technical developments in multislice CT, part 2: sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174:1022–1027CrossRefPubMedGoogle Scholar
  27. 27.
    Lee J, Choe Y, Kim H, Park J (2003) Magnetic resonance imaging demonstration of anomalous origin of the right coronary artery from the left coronary sinus associated with acute myocardial infarction. J Comput Assist Tomogr 27:289–291Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Heshui Shi
    • 1
  • Andrik J. Aschoff
    • 1
  • Hans-Juergen Brambs
    • 1
  • Martin H. K. Hoffmann
    • 1
    Email author
  1. 1.Department of RadiologyUniversity of UlmUlmGermany

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