title: Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery.
abstract: There has been a lack of standardized workup guidelines for patients with congenital abnormal origin of a coronary artery from the opposite sinus (ACAOS). We aimed to evaluate the use of cardiac hybrid imaging using multi-detector row CT (MDCT) for coronary CT angiography (Coronary CTA) and stress-rest myocardial perfusion SPECT (MPS) for comprehensive diagnosis of symptomatic adult patients with ACAOS. Seventeen symptomatic patients (12 men; 54 ± 13 years) presenting with ACAOS underwent coronary CTA and MPS. Imaging data were analyzed by conventional means, and with additional use of 3D image fusion to allocate stress induced perfusion defects (PD) to their supplying coronary arteries. An anomalous RCA arose from the left anterior sinus in eight patients, an abnormal origin from the right sinus was detected in nine patients (5 left coronary arteries, LCA and 4 LCx). Five of the 17 patients (29%) demonstrated a reversible PD in MPS. There was no correlation between the anatomical variants of ACAOS and the presence of myocardial ischemia. Image fusion enabled the allocation of reversible PD to the anomalous vessel in three patients (two cases in the RCA and the other in the LCA territory); PD in two patients were allocated to the territory of artery giving rise to the anomalies, rather than the anomalies themselves. In a small cohort of adult symptomatic patients with ACAOS anomaly there was no relation found between the specific anatomical variant and the appearance of stress induced myocardial ischemia using cardiac hybrid imaging.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Marchioninistr 15, 81377 Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Uebleis
authors.forename: M
authors.initials: M
authors.lastname: Groebner
authors.forename: F
authors.initials: F
authors.lastname: von Ziegler
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: C
authors.initials: C
authors.lastname: Rischpler
authors.forename: R
authors.initials: R
authors.lastname: Tegtmeyer
authors.forename: C
authors.initials: C
authors.lastname: Becker
authors.forename: S
authors.initials: S
authors.lastname: Lehner
authors.forename: A R
authors.initials: AR
authors.lastname: Haug
authors.forename: P
authors.initials: P
authors.lastname: Cumming
authors.forename: P
authors.initials: P
authors.lastname: Bartenstein
authors.forename: W M
authors.initials: WM
authors.lastname: Franz
authors.forename: M
authors.initials: M
authors.lastname: Hacker
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004176:Dipyridamole; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole