Additional clinical role of 64-slice multidetector computed tomography in the evaluation of coronary artery variants and anomalies

It is unknown whether multidetector computed tomography (MDCT) has an additional clinical value compared to invasive coronary angiography (ICA) in the characterization of congenital coronary artery anomalies (CAA). We studied 2757 consecutive patients with 64-slice MDCT and classified CAA according to anatomical criteria and pathophysiology-clinical relevance. The prevalence of anatomical variants was: left dominance circulation (8%), absence of left main artery (1.3%), presence of intermediate ramus (22.6%), origin of conus branch from aorta (10.6%) and of the sinus node branch from the left circumflex coronary artery (15.3%). Among 380 CAA (13.8 %) detected with MDCT, 322 (85%) were an occasional finding. In the remaining 58 patients, MDCT performed after ICA confirmed CAA in 40 (69%) cases and detected or provided additional and more detailed informations in 18 (31%). Of these 18 patients, 14 showed malignant CAA. MDCT is the ideal method for the evaluation of CAA, not only allowing a precise anatomic visualization of coronary tree, but also adding important details in malignant congenital anomalies.