title: Multimodality Imaging in the Assessment of the Physiological Significance of Myocardial Bridging.
abstract: In myocardial bridging (MB) a segment of the coronary artery is covered by the myocardium. MB can be seen as a systolic compression by invasive coronary angiography (ICA) or as an intramural course by computed tomography angiography (CTA). Intramural course is a common incidental finding in CTA studies. Only minority of the bridging segments are associated with systolic compression causing a possible impairment of myocardial perfusion. The relationship between myocardial blood flow and MB is complex and poorly evaluated by anatomic imaging. Furthermore, provocation tests are frequently needed to uncover systolic compression. Fractional flow reserve can be used to assess the hemodynamic significance of MB. Nuclear perfusion imaging can demonstrate flow abnormalities associated with MB. Stress echocardiography can demonstrate ischemic wall motion abnormalities. They can be complemented by hybrid imaging with CTA to distinguish epicardial coronary artery disease and MB. This article will review different imaging modalities for the evaluation of the physiologic significance of MB.
authors.affiliation: Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. vauusi@utu.fi.
authors.forename: Valtteri
authors.initials: V
authors.lastname: Uusitalo
authors.affiliation: Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.|Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Saraste
authors.affiliation: Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.|Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, University of Turku, Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Knuuti
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology*; D025401:Echocardiography, Stress; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D064847:Multimodal Imaging; D054084:Myocardial Bridging / Q000175:diagnosis* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D012039:Regional Blood Flow; D012720:Severity of Illness Index
keywords: Computed tomography angiography; Hybrid imaging; Invasive coronary angiography; Myocardial bridging; Positron emission tomography; Single-photon emission computed tomography