Multi-slice computed tomography and the detection of anomalies of coronary arteries.

Objectives: Congenital anomalies of the coronary arteries, even if rare, may have sudden death or myocardial infarction as the first clinical manifestations: thus, it is clear that an early diagnosis has a paramount importance for patients at risk. We present a set of cases advocating the use of multi-slice computed tomography (MSCT) in the detection of coronary artery anomalies. The majority of cases had previously undergone conventional coronary angiography, which, despite being considered the gold standard for the diagnosis of the coronary artery pathologies, often yielded incomplete results.

Methods: In 439 consecutive patients examined over 22 months by MSCT for the study of heart and coronary arteries, 11 were diagnosed for anomalous coronary artery. All patients were symptomatic for one or more of the following: chest pain, dyspnoea, palpitations, myocardial infarction and resuscitated cardiac arrest. Eight patients had previously undergone a coronary angiography.

Results: In the selected patients, seven different types of coronary anomalies were found by MSCT examination. In all cases, this technique was able to recognize the origin of the anomalous coronary artery, its three-dimensional course and its spatial relationship with the adjacent structures, even when conventional coronary angiography was performed but was unable to provide sufficient information for a correct and complete diagnosis.

Conclusions: MSCT is an accurate technique for detecting coronary artery anomalies and visualizing their three-dimensional origin and course, and their relationship with the great vessels. It may be considered as the first-choice imaging modality when an anomalous coronary artery is suspected.