Abstract
Background Coronary artery anomalies encompass a clinically and anatomically variable spectrum
including physiological variants and pathophysiologically relevant anomalies. The
majority of the variants has no hemodynamic relevance and is often detected accidentally.
The recognition of the rare and relevant anomalies that cause either relevant shunt
volumes leading to myocardial ischemia or ventricular tachyarrhythmias with the risk
of sudden cardiac death is of major importance.
Methods This review is based on a literature search in PubMed conducted using the key words
“coronary artery” and/or “anomaly” and/or “anomalous origin” and/or “myocardial bridging”
and/or “coronary artery fistula” and/or “Bland-White-Garland” and/or “ALCAPA”.
Results and Conclusion Coronary artery anomalies can be anatomically subdivided into anomalies of origin,
course and termination. The method of choice for anatomical imaging is ECG-triggered
or gated multislice CT (MSCT) that provides high spatial resolution and the capability
of multiplanar reconstructions. It facilitates the delineation of the precise course
of all three coronary arteries and thus allows for correct classification in the anatomical
classification system of coronary artery anomalies. The strengths of cardiac magnetic
resonance imaging (CMR) are the evaluation of cardiac morphology, myocardial tissue
properties and myocardial function. Basic methods are the analysis of myocardial contraction
and perfusion with and without pharmacologic stress. Furthermore, potential shunt
volumes could be quantified by phase contrast imaging or volumetry.
Key points
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Coronary artery anomalies are subdivided into anomalies of origin, course and termination.
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The main imaging task is the differentiation of hemodynamically relevant anomalies
from anatomic variants.
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The method of choice for anatomical imaging is MSCT, whereas structural and functional
information is obtained by CMR
Citation Format
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Heermann P, Heindel W, Schülke C. Coronary Artery Anomalies: Diagnosis and Classification
based on Cardiac CT and MRI (CMR) – from ALCAPA to Anomalies of Termination. Fortschr
Röntgenstr 2017; 189: 29 – 38
Key words
coronary artery anomalies - Bland-White-Garland syndrome - ALCAPA syndrome - anomalous
origin of a coronary artery - myocardial bridging - coronary artery fistula - Cardiac
CT - Cardiac MRI (CMR)
