Stress-rest dynamic-CT myocardial perfusion imaging in the management of myocardial bridging: A "one-stop shop" exam

Nicolò Schicchi; Marco Fogante; Enrico Paolini; Fatjon Cela; Paolo Esposto Pirani; Gian Piero Perna

doi:10.1016/j.jccase.2023.08.002

Stress-rest dynamic-CT myocardial perfusion imaging in the management of myocardial bridging: A "one-stop shop" exam

J Cardiol Cases. 2023 Aug 16;28(6):229-232. doi: 10.1016/j.jccase.2023.08.002. eCollection 2023 Dec.

Authors

Nicolò Schicchi¹, Marco Fogante², Enrico Paolini³, Fatjon Cela², Paolo Esposto Pirani², Gian Piero Perna³

Affiliations

¹ S.O.S. Diagnostica Radiologica Cardiovascolare, Department of Radiology, Marche University Hospital, Ancona, Italy.
² S.O.D. Radiologia Materno Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, Department of Radiology, Marche University Hospital, Ancona, Italy.
³ Cardiologia e UTIC, Cardiovascular Department, Marche University Hospital, Ancona, Italy.

Abstract

Myocardial bridging (MB) is a congenital anomaly characterized by the intramyocardial coronary course that can cause coronary compression during systole leading to myocardial ischemia, often with the concomitant presence of endothelial dysfunction.Improvements in computed tomography (CT) technology have increased the burden of MB detection during coronary-CT (cCT) but their anatomical and functional assessment is often challenging. A stress-rest myocardial perfusion imaging (MPI) by single-photon emission CT (SPECT) is usually required to decide the correct patient management. However, SPECT has long acquisition protocols, poor spatial resolution, and significant radiation doses for the patient. The recent advances in CT scan technology have allowed the evaluation of stress-rest MPI, representing a promising alternative to SPECT.In this paper, we report six cases of MBs assessed with cCT examination and further evaluated with a stress-rest dynamic-CT MPI and SPECT. A reversible perfusion defect in the left anterior descending (LAD) territory segments potentially due to MB was detected in two of six patients, and they were referred for heart team evaluation.In conclusion, cCT and stress-rest dynamic-CT MPI allowed to detect MBs, evaluate their functional significance, and decide the patients' management in a "one-stop shop" examination.

Learning objective: Improvements in computed tomography (CT) technology have increased the burden of myocardial bridging (MB) detection during coronary-CT but their anatomical and functional assessment is often challenging.A stress-rest myocardial perfusion imaging (MPI) by single-photon emission CT (SPECT) is then usually required to decide the correct patient management.Recent advances in CT scan technology have allowed the evaluation of stress-rest MPI, that represent a promising alternative to SPECT.

Keywords: Cardiac computed tomography; MINOCA; Myocardial bridging; Myocardial ischemia; Myocardial perfusion imaging.

Publication types

Case Reports