Multimodality Imaging in Coronary Artery Anomalies: Current Standards and Future Perspectives

Coronary artery anomalies (CAA) are relatively rare and underdiagnosed congenital heart disease spectrum, however, becoming more visible along with imaging diagnostic advancements. The linkage between a benign course of arteries and serious complications, even as sudden cardiac death, underscores the importance of CAA diagnosis and assessing its effect on heart muscle physiology. Computed tomography with intravenous contrast administration remains the gold standard of imaging, allowing for the depiction of the origin, segments of coronary branches and termination, making it possible to detect the high-risk anatomical variants. However, its limitations, described in the text, are present. In the context of initial imaging, or in the specific vulnerable groups of patients (pediatric population, pregnant women), echocardiography and cardiac magnetic resonance have become important tools. The article describes and depicts unique signs, related to specific CAA, possible to detect with echocardiography-"crossed aorta sign," "bleb sign," and "Christmas tree sign." Cardiac magnetic resonance remains useful when analyzing the hemodynamic consequences of CAA and describing the tissue changes, such as myocardial fibrosis, edema, and scarring. Nuclear imaging, Single-Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) are tools to assess perfusion and detect ischemia, allowing to precisely describe the physiological effect of anatomical change and impacting the decision of a surgery. In the context of future development, Virtual Reality (VR) and Augmented Reality (AR) should be taken into account and require more studies. This text integrates the profound description of non-invasive imaging methods being supplementary to each other and presents illustrative cases, which allowed to show the clinical background.