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Objective: To assess the clinical value of multi-detector computed tomography (MDCT) source image on detecting extracoronary abnormalities in a large cohort of patients with suspected coronary artery disease (CAD)., Method: MDCT source images from 3240 consecutive patients (mean 64.5 years) with suspected CAD were reviewed retrospectively by 2 readers.Extra-coronary findings were classified according to involved organ and level of clinical significance.Following organs were examined:lungs, upper abdomen, spine, chest wall, mediastinum and vascularatures. Clinical relevance of extracoronary findings was considered as either "significant" or "non-significant"."Significant" findings were subclassified as score 1:findings necessitating immediate therapeutic actions, or score 2:findings with uncertain clinical or prognostic relevance, requiring clinical awareness, follow-up or further investigations (non-urgent)."Non-significant" findings were assigned to score 3:findings without clinical implication. The irrelevant incidental findings (e.g. spinal degenerative changes, aortic calcification) were not analyzed., Results: Extracoronary findings was evidenced in 330 patients with 424 abnormalities, 20.3% (67/330) patients had multiple lesions, 16.5% lesions were located in the lungs, 13.2% lesions found in the upper abdomen, 56.8% (241/424) lesions evidenced in the mediastinum,0.9% (4/424) lesions seen in the spine and chest wall, 13.9% (53/424) lesions were related to other vascular disease. Pleural effusion accounts for 5.5% of the mediastinum lesions.Incidence of heart cavity enlargement, heart valve disease, pericardial effusion/calcification, atrial/ventricular perfusion defects, myocardial disease, congenital heart disease, ventricular aneurysm was 14.7% (56/380), 15.5% (59/380), 10.8% (41/380), 3.9% (15/380), 0.8% (3/380), 1.6% (6/380), and 1.8% (7/380) respectively. The clinical significance score 1-3 was 8.5% (36/424) , 81.1% (344/424) , and 10.4% (44/424) respectively.Incidence of detected extracoronary findings was the highest by bone window and the lowest by lung window.Incidence of extracoronary findings was not related to CAD (χ2 = 81.76, C = 0.155, P > 0.05).Inter-reader agreement on extracoronary findings was excellent (Kappa = 0.934, P > 0.05)., Conclusion: Our data show that it is of clinical value to observe and report extracoronary findings with source image of cardiac MDCT.

Objective: To evaluate the incidence, types and clinical significance of coronary artery fistula (CAF) on CT coronary angiography (CTCA)., Methods: A total of 48 533 consecutive patients undergoing CTCA at 4 Chinese hospitals were retrospectively analyzed. The incidence, types and clinical significance of CAF were retrospectively summarized., Results: One hundred and two patients had CAF with the incidence of 0.21% (102/48 533). Among them, coronary to pulmonary artery fistulas were seen in 92 patients (90.2%, 92/102), coronary to right atrium fistula in 4 (3.9%, 4/102), coronary to right ventricular fistula in 2 (2.0%, 2/102), coronary to right ventricular fistula in 2 (2.0%, 2/102), coronary to left atrium fistula in 1 (1.0%, 1/102) and coronary to small cardiac vein in 1 (1.0%, 1/102). Among 92 coronary to pulmonary artery fistulas, fistulas originated from both coronary arteries in 46 patients (50.0%, 46/92), from left coronary artery in 28 (30.4%, 28/92) and right coronary artery in 11 (12.0%, 11/92) and the remaining 7 (7.6%, 7/92) coronary to pulmonary artery fistulas were associated with extracardiac communications., Conclusion: The incidence of CAF is 0.21% with a predominance of coronary to pulmonary artery fistulas (90.2%). The most common type of CAF is coronary to pulmonary artery fistulas from both coronary arteries (50.0%). Dual source CTCA can clearly visualize types and abnormal vessels so that it plays an important role in the diagnosis and preoperative evaluation of CAF.

Objective: To assess the ability to detect myocardial bridging (MB) of dual-source computed tomography (DSCT) compared with conventional coronary angiography (CAG)., Methods: Both DSCT coronary angiography (DSCTCA) and CAG were performed on 53 patients diagnosed or suspected as with coronary artery disease (CAD), 45 males and 8 females, aged 36-87. 4D cine mode was performed on 16 of these 53 patients with MB shown on DSCTCA, and the CAG data were reviewed retrospectively by automatic cine method. The MB findings by both methods were compared. The diameters of segments proximal to and distal to MB, tunneled coronary arteries at systolic and diastolic phases were measured, and stenosis rate of tunneled coronary arteries was computed according to the equation. The relationship between stenosis rate of tunneled artery and milking effect on 4D cine mode was analyzed., Results: Of the 53 patients who had undergone CAG; 4 images of MB were detected in 3 patients based on the CAG findings, with a detection rate of 5.7%, significantly than that by DSCT (30.2%, 21 images of MB in 16 patients, chi2 = 10. 837, P = 0.001). 4D cine mode showed various degrees of "milking effect" and abnormal blood flow in 16 patients with MB. The stenosis rate of tunneled artery during systole was related to the "milking effect" rate on 4D cine mode of DSCTCA (r = 0.640, P = 0.006)., Conclusion: More vividly and reliably showing the "milking effect" than CAG, DSCT can be used as a routine screening method to detect or exclude MB.