Casolo Giancarlo, Del Meglio Jacopo, Rega Luigi, Manta Rosanna, Margheri Massimo, Villari Natale, Gensini Gianfranco
Clinica Medica e Cardiologia, Azienda Universitaria Ospedaliera Careggi, Viale Morgagni 85, 50123 Florence, Italy.
Int J Cardiol. 2005 Sep 1;103(3):317-22. doi: 10.1016/j.ijcard.2004.09.007.
Coronary artery anomalies (CAAs) are a relatively rare condition usually diagnosed in vivo by conventional angiography. In the past few years Magnetic resonance coronary angiography (MRCA) has been used to detect CAAs and found to be highly accurate. No data is available regarding the ability of MRCA to detect previously not suspected anomalies.
We prospectively analyzed the origin and course of 336 patients undergoing a diagnostic Cardiovascular magnetic resonance (CMR) study. After the completion of a standard examination a navigator-echo 3D-MRCA low-quality scan was used in all the cases to rule out CAAs. The high-quality MRCA was applied only if an abnormal coronary arterial tree was seen.
Nineteen patients with CAAs (12 men, 7 women; mean age, 53+/-18 years) were identified by MRCA. Six out of the 19 CAAs subjects had already been detected by other means (coronary angiography in 5, and transesophageal echocardiography in 1 case). However in none of them a complete anatomical assessment was achieved. In 13 patients CAAs were an unexpected and new finding. MRCA was able to assess the origin and proximal course of the anomalous artery in all the cases.
MRCA is able to detect the presence and anomalous course of CAAs. Besides offering precise information about already suspected CAAs, MRCA can identify anomalies previously not suspected. This study suggests a potential role for MRCA as a screening tool for CAAs in young patients with angina, ventricular arrhythmias, or unexplained syncope as well as in highly competitive athletes.
冠状动脉异常（CAA）是一种相对罕见的疾病，通常通过传统血管造影在体内进行诊断。在过去几年中，磁共振冠状动脉造影（MRCA）已被用于检测CAA，并被发现具有高度准确性。目前尚无关于MRCA检测先前未怀疑异常的能力的数据。
我们前瞻性分析了336例接受诊断性心血管磁共振（CMR）检查患者的冠状动脉起源和走行。在完成标准检查后，所有病例均使用导航回波3D-MRCA低质量扫描以排除CAA。仅在观察到冠状动脉树异常时才应用高质量MRCA。
通过MRCA识别出19例CAA患者（12例男性，7例女性；平均年龄53±18岁）。19例CAA患者中有6例已通过其他方法检测到（5例通过冠状动脉造影，1例通过经食管超声心动图）。然而，在这些病例中均未实现完整的解剖学评估。在13例患者中，CAA是意外的新发现。MRCA能够在所有病例中评估异常动脉的起源和近端走行。
MRCA能够检测CAA的存在及其异常走行。除了提供有关已怀疑CAA的精确信息外，MRCA还可以识别先前未怀疑的异常。这项研究表明，MRCA在患有心绞痛、室性心律失常或不明原因晕厥的年轻患者以及竞技性很强的运动员中作为CAA筛查工具具有潜在作用。
