Role of MDCT Angiography in Diagnosis and Evaluation of Anatomical Variations and Anomalies of the Coronary Arteries

Abstract

Background: Coronary anomalies are often asymptomatic and may be accidentally discovered. With the increase of interventional coronary procedures, the detection of coronary anomalies is becoming of major clinical importance, the coronary anomalies cannot be considered just rare aspects because they may often lead to relevant clinical consequences. That is reason why the diagnosis of coronary anomalies should be a healthcare priority. Aim of the Study: This study was designed to identify the MDCTA appearance of the anatomic variations and anomalies of the coronary arteries and determine their prevalence. Patients and Methods: This study was conducted as a cross-sectional study in Radio-Diagnosis Department, Faculty of Medicine, Ain Shams University and other specialized private radiology centers, during the period between December 2017 and June 2018. All patients gave their written informed consent for taking part in this study. Patients inclusive of 70 males and 50 females with their ages ranged between 4-82 years. The study was approved by Ethical Committee of Faculty of medicine, Ain Shams University. It included 120 patients that were referred for MDCTA for coronary arteries study, Patients were referred for coronary CTA because of known or suspected coronary artery disease (CAD). Results: The total number of studies population were 100. 60 (60%) were males ages ranging 4-82 years and 49.5± 11.3 years mean age, and 40 (40%) were females with 25-77 age group and 52.75 years mean age.In 79 patients out of 100 (79%), the RCA was dominant giving off PDA and PLB, in 11 patients (11%) the left coronary artery was dominant and in the remaining patients 10 (10%) were Co-dominant. in 2% the LMCA originated from right sinus of valsalva with interarterial course. In 23.46 % the LMCA trifurcated to LAD, LCx and an intermediate ramus artery. The LAD showed myocardial bridging 16% more than other coronary arteries. One coronary aneurysm seen in the LAD.The LCx had abnormal origin from Rt. coronary sinus in two patients (2%) with retro aortic course. The myocardial bridging is very rare in LCX, present in 1% only. LCx fistula also rare detected in 1 patient (1%), no aneurysm was detected in the LCx. The origin of RCA was from right sinus of valsalva in 99 patients (99%) while one patient had abnormal origin from left coronary sinus (1%), in this case the RCA course was inter-arterial. In general, the normal variations and anomalies of coronary arteries were more common in LMCA 27%, in LAD 19%, LCx was 9 % and least 3% in RCA. Conclusion: Complex anatomy of the coronary artery system can accurately be depicted by MDCTA because of the improved isotropic spatial resolution and flexible post-processing tool. This noninvasive modality is useful in detecting coronary artery variants and anomalies and is a valid alternative to conventional coronary angiography in their diagnosis. Recommendations: Further studies are needed with large sample volume and correlate clinical presentation of patients with coronary anomalies & variant.