Open Access

ARTICLE

Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies

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Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland

* Corresponding Author: Ronny R. Buechel, Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. Email: Christoph Gr€ani and Dominik C. Benz share the first authorship.

Congenital Heart Disease 2017, 12(1), 49-57.

Abstract

Objective: To provide data on the value of fused cardiac hybrid imaging with coronary computed tomography angiography (CCTA) and positron emission tomography myocardial perfusion imaging (PET-MPI) in patients with complex coronary artery anomalies (CCAA).
Design/setting: This is a retrospective, single-center study.
Patients: Seven consecutive patients with CCAA (mean 57 ± 7 y, 86% were male) who underwent clinically indicated hybrid CCTA/PET-MPI between 2005 and 2015 in our clinic were included. The findings from both modalities and fused cardiac hybrid imaging were evaluated in these patients.
Results: Out of the seven patients with CCAA, two patients had Bland–White–Garland anomaly, two patients showed a coronary artery fistula, two patients showed a “single right,” and one patient showed a “single left” coronary artery. Semiquantitative fused hybrid CCTA/PET-MPI depicted inferolateral scar matching the territory of a nonanomalous vessel with significant concomitant coronary artery disease (CAD) in one patient only. In contrast, analysis of quantitative myocardial blood flow (MBF) as assessed by fused hybrid CCTA/PET-MPI revealed abnormally reduced flow capacities in the territories subtended by the anomalous vessels in 4 patients.
Conclusions: In this case series of middle-aged patients with CCAA, perfusion defects as assessed by semiquantitative PET-MPI were rare and attributable to concomitant CAD rather than to the anomalous vessel itself. By contrast, impaired MBF as assessed by quantitative hybrid CCTA/PET-MPI was revealed in the majority of patients in the vessel territories subtended by the anomalous coronary artery itself. Fused hybrid CCTA/PET-MPI incorporating information on morphology and on semiquantitative and quantitative myocardial perfusions may provide added value for the management of patients with CCAA.

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