Type:
Educational Exhibit
Keywords:
Cardiac, Anatomy, Cardiovascular system, CT, CT-Angiography, CAD, Congenital, Not applicable
Authors:
P. chiarolanzio1, C. Shilagani2, P. Gerard2, G. Pearson1; 1Valhalla/US, 2Valhalla, NY/US
DOI:
10.26044/ecr2020/C-13682
Background
Anomalous origins of the coronary arteries vary in their clinical significance. While the majority of cases are found incidentally, certain anomalies carry an increased risk for cardiac arrhythmias and sudden cardiac death. Cardiothoracic radiologists spend the majority of their practice interpreting these anomalies; however, resident radiologists may not spend a significant portion of their training on cardiac imaging. Radiologists tend to be visual learners. By incorporating the hands-on creation of models as teaching tools, residents are able to learn complex, unfamiliar pathology with greater efficiency. For this project, clay models were used to demonstrate anomalous coronary artery anatomy, then providing the computed tomography (CT) correlation to solidify the concept.
Anomalous Origin of the Coronary Arteries:
Occurring in just about 1-2% of the population, coronary artery anomalies are exceedingly rare. Because these anomalies are usually clinically insignificant, they are often not discussed in every day practice. Within the spectrum of anomalies, however, some carry serious clinical implications. Cardiac CT is the most common imaging modality to assess the coronary arteries. CT is efficient, tolerated by most patients, and modern scanners have the ability to scan patients in fewer acquisitions. Cardiac magnetic resonance (MR) imaging continues to grow in popularity; however, it is not yet widely available, is often time consuming, and some patients are not eligible for MR. CT imaging requires a regular heart rate, slow enough to allow proper gated acquisition. Some patients, especially those with arrhythmias, may not be able to sufficiently slow their heart rate enough. If compatible, MR imaging may be preferred in these patients. Regardless, CT technologies continue to advance, with modern scanners able to acquire the entire region of interest in a single pass.
CT continues to demonstrate superiority to coronary angiography in the identification of anomalous vessels. CT also allows for additional correlation with adjacent anatomic structures. When indicated, anomalous coronary arteries usually require open repair. Seeing the vessel’s relationship with other mediastinal structures facilitates pre-surgical planning. Three-dimensional (3D) reconstruction is readily available at most CT workstations.