Ethan Joseph Halpern MD, Presenter: Grant, Bristol-Myers Squibb Company Equipment support, Toshiba Corporation

David C. Levin MD, Abstract Co-Author: Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC

Shaoxiong Zhang, Abstract Co-Author: Nothing to Disclose

Dinesh Kumar Sharma MD, Abstract Co-Author: Nothing to Disclose

To demonstrate anatomic variations in coronary artery anatomy with coronary CT angiography (CTA).

A retrospective review was performed of 1000 coronary CTA studies performed at our university center. Examinations were performed with the Brilliance Pro 40-slice and 64-slice scanners (Philips Medical Systems) with EKG-gated images obtained at 0.6-0.8mm slice thickness.

Twenty patients were identified with anatomic variations in the coronary circulation. Seven patients demonstrated an anomalous left coronary artery, 6 from the right coronary sinus and 1 from the non-coronary sinus. One patient demonstrated an anomalous circumflex artery from the right coronary sinus. Seven patients demonstrated an anomalous right coronary artery, 5 from the left coronary sinus, and 2 from above the sinotubular junction. The origin of the anomalous vessel as well as its position relative to the outflow tracts was clearly defined in all cases. For those vessels that passed between the aorta and pulmonary artery, the vessel lumen was evaluated with cine display throughout the cardiac cycle. Other anatomic variations included absence of the left main coronary artery with independent origins of the left anterior descending and circumflex arteries, a duplicated left anterior descending artery, anomalous origin of the left anterior descending artery from the conus branch of the right coronary artery, a fistulous connection between the circumflex artery and the right atrial appendage, and a fistulous connection between the right coronary artery and the coronary sinus.

Multidetector coronary CTA provides clear three dimensional depiction of coronary anatomy as well as the relationship of the coronary arteries to surrounding anatomic structures. For anomalous coronary arteries that course between the aorta and pulmonary artery, compression and kinking of anomalous vessels during the cardiac cycle may be demonstrated by cine display.

Coronary CTA provides a clear demonstration of coronary artery variations that would otherwise require cardiac catheterization for diagnosis.

Halpern, E, Levin, D, Zhang, S, Sharma, D, Anatomic Variants of Coronary Artery Anatomy Diagnosed with Multidetector CT Angiography.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5000520.html