With the evolution of multislice, multidetector cardiac CT, noninvasive imaging of small moving structures, such as coronary arteries, has become possible. Until now, imaging of the coronary arterial tree has been limited to cine arteriograms. With cardiac CT, which provides detailed anatomic information, a firm understanding of gross anatomy with an appreciation of normal origin, branching, myocardial distribution, and adjacent structures is essential for accurate image interpretation. Furthermore, without a detailed appreciation of normal anatomy, coronary artery anomalies may go undiagnosed. This article will review normal coronary arterial anatomy from both anatomic and clinical standpoints, anatomic anomalies of the coronary arteries, and applications of cardiac CT in patient evaluation.
The anatomy of the coronary vessels has been described in detail for at least 3 centuries. Strict anatomic descriptions of the coronary vessels are available from standard textbooks of gross anatomy. However, most of the textbook descriptions are based on views and perspectives obtained from tissue, emphasizing landmarks that are visible on the gross specimen. These landmarks are not easily recognizable on traditional cine radiographic images. Until recently, most radiographic and clinical descriptions of the coronary arteries have been based on cine coronary arteriograms. When studying a cine arteriogram, however, a physician uses an entirely different set of reference points and is less inclined to emphasize landmarks that are seen only on the gross specimen. Because these anatomic landmarks are not easily recognized with traditional arteriography, clinicians have adopted slightly different nomenclature to describe normal coronary anatomy, concentrating more on vessels with clinical rather than anatomic significance.
Cardiac computed tomography (CT) provides detailed anatomic information, but its use requires a firm understanding of gross coronary anatomy. Furthermore, detailed appreciation of the "normal" origin, course, branching, adjacent structures, and myocardial distribution of these vessels is vital so that variations of the "normal" anatomy can be more easily recognized and applied to clinical practice.
This article will review normal coronary arterial anatomy from both anatomic and clinical standpoints, anatomic anomalies of the coronary arteries, and applications of cardiac CT in patient evaluation.