Visualization of coronary artery anomalies and their anatomic course by contrast-enhanced electron beam tomography and three-dimensional reconstruction

Anomalous coronary arteries are rare conditions. However, they may cause my ocardial ischemia and sudden death and their reliable identification is cru cial for any imaging method that attempts coronary artery visualization. We studied the ability of contrast-enhanced electron beam tomography (EBT) to identify anomalous coronary arteries and their course. Thirty patients wit h previously identified coronary anomalies and 30 subjects with normal coro nary anatomy were studied. By EBT, 40 to 50 axial images of the heart (3-mm slice thickness, 1 mm overlap, electrocardiagraphic trigger) were acquired in a single breathhold during continuous injection of contrast agent (160 ml, 4 ml/s). Based on the original images and 3-dimensional reconstructions , the EBT data were analyzed by 2 blinded observers as to the presence of c oronary anomalies and their course. Re-suits were compared with invasive an giography. EBT correctly identified all normal controls and all patients wi th coronary anomalies. The anatomic course of the coronary anomalies was co rrectly classified in 29 of 30 patients (97%), including right-sided origin of the left main coronary artery (n = 4) or of the left circumflex coronar y artery (n = 15), left-sided origin of the right coronary artery (n = 9), and 1 coronary fistula from the left circumflex coronary artery to the righ t atrium. Only the distal anastomosis of a second fistula from the left cir cumflex coronary artery to a branchial artery was not correctly identified. This study demonstrates that contrast-enhanced EBT is a reliable noninvasi ve technique to identify anomalous coronary arteries and their course. (C) 2001 by Excerpta Medico, Inc.