Malignant right coronary artery anomaly simulated by motion artifacts on MDCT.
OBJECTIVE
The aim of our study was to determine the prevalence of anomalous right coronary artery imitation due to motion artifacts in MDCT. Routine chest MDCT for reasons other than cardiac or vascular imaging is usually performed using breath-hold technique but without retrospective ECG gating and consequently yields pulsating motion artifacts. A possible artifact in front of the aortic root imitates an anomalous right coronary artery originating from the left posterior sinus. This course of the right coronary artery is considered a malignant variant and raises the question of far-reaching consequences such as a bypass operation.


METHODS
We performed a prospective study involving 355 patients undergoing routine chest CT examinations. To determine the prevalence of anomalous right coronary artery imitation caused by this motion artifact, all images were evaluated prospectively by an experienced radiologist.


RESULTS
Twenty-one patients (5.9%) were suspected of having a malignant variant of the right coronary artery. However, in all patients prior chest CT or additional coronary MR angiography showed a normal origin of the right coronary artery.


CONCLUSIONS
Routine chest MDCT without retrospective ECG gating may produce artifacts around the aorta simulating a malignant variant of the right coronary artery. Considering the low incidence of this malignant interarterial variant, the need for routine chest CT examinations combined with ECG gating and further workup can be disputed from an economic point of view. This artifact should be known to avoid unnecessary further examinations.
Katoh
Marcus
M
Department of Diagnostic Radiology, University Hospital Aachen, University of Technology (RWTH), Pauwelsstrasse 30, Aachen 52057, Germany.
Wildberger
Joachim E
JE
Günther
Rolf W
RW
Buecker
Arno
A
D000328:Adult; D000368:Aged; D016477:Artifacts; D003287:Contrast Media; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide