Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT
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Abstract
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.
Keywords
Coronary vessels Abnormalities Coronary angiography Computed tomography Angiography Image processing Multidetector rowNotes
Acknowledgment
Vital Images (Plymouth, MN) is kindly acknowledged for providing us with the Beta release of their Vitrea2 software.
References
- 1.Albert CM, Mittleman MA, Chae CU et al (2000) Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 343:1355–1361CrossRefPubMedGoogle Scholar
- 2.McCrohon JA, Moon JC, Prasad SK et al (2003) Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 108:54–59CrossRefPubMedGoogle Scholar
- 3.Mohlenkamp S, Lehmann N, Schmermund A et al (2003) Prognostic value of extensive coronary calcium quantities in symptomatic males—a 5-year follow-up study. Eur Heart J 24:845–854CrossRefPubMedGoogle Scholar
- 4.King DG (2002) Electron beam computed tomographic scanning in preventive medicine. Prev Cardiol 5:59–60PubMedGoogle Scholar
- 5.Kopp AF, Schroeder S, Kuettner A et al (2002) Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients. Eur Heart J 23:1714–1725PubMedGoogle Scholar
- 6.Rodenwaldt J (2003) Multislice computed tomography of the coronary arteries. Eur Radiol 13:748–757PubMedGoogle Scholar
- 7.Vliegenthart R, Oudkerk M, Song B et al (2002) Coronary calcification detected by electron-beam computed tomography and myocardial infarction. The Rotterdam Coronary Calcification Study. Eur Heart J 23:1596–1603CrossRefPubMedGoogle Scholar
- 8.Dirksen MS, Bax JJ, Blom NA et al (2002) Detection of malignant right coronary artery anomaly by multi-slice CT coronary angiography. Eur Radiol 12:S177–S180PubMedGoogle Scholar
- 9.Sevrukov A, Aker N, Sullivan C et al (2002) Identifying the course of an anomalous left coronary artery using contrast-enhanced electron beam tomography and three-dimensional reconstruction. Catheter Cardiovasc Interv 57:532–536CrossRefPubMedGoogle Scholar
- 10.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
- 11.Bittl JA, Levin DC (1997) Coronary arteriography. In: Braunwald E (ed) Heart disease—a textbook of cardiovascular medicine, vol 1. Saunders, Philadelphia, pp 240–272Google Scholar
- 12.McConnell MV, Ganz P, Selwyn AP et al (1995) Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 92:3158–3162PubMedGoogle Scholar
- 13.Post JC, van Rossum AC, Bronzwaer JG et al (1995) Magnetic resonance angiography of anomalous coronary arteries: a new gold standard for delineating the proximal course. Circulation 92:3163–3171PubMedGoogle Scholar
- 14.Vliegen HW, Doornbos J, de Roos A et al (1997) Value of fast gradient echo magnetic resonance angiography as an adjunct to coronary arteriography in detecting and confirming the course of clinically significant coronary artery anomalies. Am J Cardiol 79:773–776CrossRefPubMedGoogle Scholar
- 15.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
- 16.Spuentrup E, Buecker A, Stuber M et al (2003) Visualization of anomalous coronary artery in the presence of arrhythmia using radial balanced fast field echo coronary magnetic resonance angiography. Circulation 107:e214CrossRefPubMedGoogle Scholar
- 17.Ropers D, Regenfus M, Stilianakis N et al (2002) A direct comparison of non-invasive coronary angiography by electron beam tomography and navigator-echo-based magnetic resonance imaging for the detection of restenosis following coronary angioplasty. Invest Radiol 37:386–392CrossRefPubMedGoogle Scholar
- 18.Nikolaou K, Huber A, Knez A et al (2002) Intraindividual comparison of contrast-enhanced electron-beam computed tomography and navigator-echo-based magnetic resonance imaging for noninvasive coronary artery angiography. Eur Radiol 12:1663–1671CrossRefPubMedGoogle Scholar
- 19.Budoff MJ, Achenbach S, Duerinckx A (2003) Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography. J Am Coll Cardiol 32:1867–1878CrossRefGoogle Scholar
- 20.van Ooijen PM, Dorgelo J, Oudkerk M (2003) Noninvasive coronary imaging: CT versus MR. Herz 28:143–149CrossRefPubMedGoogle Scholar
- 21.Funabashi N, Kobayashi Y, Rubin GD (2001) Utility of three-dimensional volume rendering images using electron-beam computed tomography to evaluate possible causes of ischemia from an anomalous origin of the right coronary artery from the left sinus of valsalva. Jpn Circ J 65:575–578CrossRefPubMedGoogle Scholar
- 22.Lee JL, Kang D (2001) Feasibility of electron beam tomography in diagnosis of congenital heart disease: comparison with echocardiography. Eur J Radiol 38:185–190CrossRefPubMedGoogle Scholar
- 23.Ropers D, Moshage W, Daniel WG et al (2001) Visualization of coronary artery anomalies and their anatomic course by contrast-enhanced electron beam tomography and three-dimensional reconstruction. Am J Cardiol 87:193–197CrossRefPubMedGoogle Scholar
- 24.Ropers D, G Gehling, K Pohle et al (2002) Images in cardiovascular medicine. 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:e42–e43CrossRefPubMedGoogle Scholar
- 25.Li W, Ferrett C, Henein M (2003) Anomalous coronary arteries by electron beam angiography. Circulation 107:2630PubMedGoogle Scholar
- 26.Sapoval MR, Mousseaux E, Desnos M (1995) Anomalous origin of the left coronary artery from the right coronary sinus diagnosed by electron beam computerized tomography. Circulation 107:2093PubMedGoogle Scholar
- 27.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
- 28.Nieman K, Oudkerk M, Rensing BJ et al (2001) Coronary angiography with multi-slice computed tomography. Lancet 357:599–603CrossRefPubMedGoogle Scholar