Evaluation of coronary artery variations and anomalies with multislice computed tomography

Introduction and Objective: With the advancement of computed tomography (CT) technology, nowadays definition of coronary anatomy, coronary artery variants and coronary artery anomalies can be performed easily with CT. The aim of our study is to evaluate the prevalence and characteristics of variations and anomalies of coronary arteries in patients undergoing coronary CT angiography in our center. Materials and Method: Between 31.01.2008 and 20.04.2017, variants of coronary artery anatomy were examined retrospectively in 1200 consecutive patients who underwent 64 coronary angiography and 256 coronary angiography in Dicle University Medical Faculty Radiology Department. Of the 1200 patients, 601 (50.08%) were evaluated with 256-section CT and 599 (49.92%) with 64-section CT. All examinations were performed on retrospective ECG triggered 64-section and 256-section CT workstations equipped with cardiac reconstruction software. Results: The right dominance in 88.6%, left dominance in 9.6% and codominance in 1.8% were observed in 1200 cases who were studied. Conus artery in our study; 61% of patients were receiving origin from proximal RCA, 21% from ostial RCA, 15.5% from aorta. Conus artery was not evaluated in 2.5% of cases. As the second branch of RCA, the sinoatrial node was observed in 79% of the cases, whereas in 12.4% of the cases the origin of SA node was from LCX artery. The SA nodal artery was originated from both RCA and LCX in 4.1% of cases. In 4.5% of cases, SA node arterias could not be evaluated. 33.6% of the cases had ramus intermedius arteriosus. Diameter of ramus intermedius artery ranged from 0.4 to 4.5 mm. Myocardial bridge was observed in 12.1% of the cases and most of the cases were observed in LAD. Coronary ectasia-aneurysm was observed in 1.75% of the cases and most of the coronary artery ectasia-aneurysms were observed in RCA. High take-off anomaly was observed in 1.3% of the cases and the majority of the cases were caused by LMCA. In 6 case LMCA and RCA emerged as the only origin from the right sinus valsalva. In 5 case RCA emerged origin from separate the left sinus valsalva. In the 2 case LMCA was directly originating from the right sinus valsalva. In 1 case LMCA originated from noncoronary sinus. In 9 cases LCX and in 2 cases LAD was originated from the right sinus valsalva. In addition, our study had anomaly of termination in 7 cases. Conclusion: In our society, coronary variations and anomalies are widely observed. While some of these variations and anomalies are consistent with the literature, some are incompatible. Coronary CT angiography is a reliable audit for the detection of variations and anomalies of coronary arteries and may lead to diagnosis, treatment and surgical planning with the possibility of high geometric-temporal resolution and reformat imaging.