Learning objectives
Review normal anatomy of coronary arteries on cardiac CT angiography.
Enable identification and descriptionof aberrant coronary artery origins on cardiac CT angiography.
Understand the clinical significance of certain aberrant coronary artery origins.
Outline the management strategies that may be employed to address these.
Background
Since the introduction of multi-detector row CT,
electrocardiographically (ECG)-gated scanning and dedicated reconstruction algorithms,
computed tomography (CT) of the coronary arterieshas become acommonly performed diagnostic imaging technique 1.
CT angiography is a non-invasive and accurate method to detect haemodynamically significant proximal coronary artery stenoses,
with a sensitivity between 80-90% 2,3.
Furthermore,
multi–detector row CT is nowan accepted and accurate diagnostic tool for defining coronary artery anomalies,
andmay be superior to conventional angiography in defining the ostial origin and proximal path of anomalous coronary branches 4....
Findings and procedure details
Normal Anatomy
The aortic valve consists of three cusps with curvilinear attachments to the aortic ring.These are known as the left coronary cusp,
right coronary cusp and posterior non-coronary cusp Fig. 1.
On the superior/aortic sides of these cusps are small anatomic dilatations of the aortic root,forming the three sinuses of Valsalva.The coronary arteries arise from these sinuses,
which are named the left,
right and non-coronary (posterior) sinuses.
Above the sinuses,
the tubular portion of the ascending aorta begins (sinotubular junction).
The functional unit from...
Conclusion
Aberrant origin of a coronary artery is a relatively common incidental finding when performing CT coronary angiography.
Familiarity with the CT appearances of various aberrant coronary artery origins and an understanding of the clinical significance of these anomalies are essential in making a correct diagnosis and planning patient treatment.
References
Pannu HK,
Flohr TG,
Corl FM,
Fishman EK.
Current concepts in multi–detector row CT evaluation of the coronary arteries: principles,
techniques,
and anatomy.
RadioGraphics.
2003; 23:S111
Nieman K,
Cademartiri F,
Lemos PA,
Raaijmakers R,
Pattynama P,
de Feyter PJ.
Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography.
Circulation.2002;106:2051–2054
Kim SY,
Seo JB,
Do KH et al.
Coronary Artery Anomalies: Classification and ECG-gated Multi–Detector Row CT Findings with Angiographic Correlation.
RadioGraphics.
Mar 2006; Vol.
26,
No.
2
Shi H,
Aschoff AJ,
Brambs HJ,...