Coronary artery anomalies and normal anatomical variants in coronary computed tomography angiography (CCTA): a pictorial essay

Abstract

It is important to differentiate between coronary artery anomalies and normal anatomical variants. Several imaging modalities, such as echocardiography, invasive coronary angiography (ICA), coronary magnetic resonance imaging (CMRI), and coronary computed tomography angiography (CCTA), are used. The gold standard for assessing coronary artery anomalies and normal anatomical variants is CCTA. CCTA has high spatial and temporal resolution, multiplanar reconstruction, adequate isotropic resolution with a large field of view, and detailed noninvasive visualization of coronary artery anatomy. Normal anatomical variants show no hemodynamic changes and are usually incidental findings. Coronary artery anomalies are rare and classified by origin, origin/course, course, and termination. In many cases, patients with coronary artery anomalies are asymptomatic, and some anomalies have a hemodynamic impact. There are high-risk anatomical features of malignant coronary artery anomalies, which, under stress, can cause ischemia in the areas perfused by the anomalous vessel and are associated with myocardial ischemia, ventricular arrhythmias, heart failure, or sudden death. The radiologist should differentiate coronary artery anomalies and normal anatomical variants to make a correct radiological-clinical correlation and recognize the advantages of CCTA in diagnosis. This pictorial essay shows the CCTA findings of coronary artery anomalies and normal anatomical variants.