Associazione Nazionale Medici Cardiologi Ospedalieri



Stress-rest dynamic-CT myocardial perfusion imaging in the management of myocardial bridging: a “one-stop shop” exam.

Perna Gian Piero Ancona (Ancona) – Cardiologia E Utic | Schicchi Nicolò Ancona (Ancona) – Radiologia | Fogante Marco Ancona (Ancona) – Radiologia | Pirani Paolo Ancona (Ancona) – Radiologia | Paolini Enrico Ancona (Ancona) – Cardiologia E Utic

Myocardial bridging (MB) is a congenital anomaly characterized by intramyocardial coronary

course that can cause coronary compression during systole and can lead to myocardial ischemia.

The improvement in computed tomography (CT) scanner technology has increased the detection

of MB during coronary-CT (cCT) exam but the assessment of their functional significance is often

challenging. Tha stress-rest myocardial perfusion imaging (MPI) single-photon emission CT (SPECT)

is often required to decide patient’s management after anatomical evaluation with cCT or Invasine Coronary Angiography  (ICA). However, SPECT has long acquisition protocols, poor spatial resolution, and the anatomical/Functional protocols expose patients to significant radiation doses. Thus , dynamic-CT MPI after cCGT can represent a valid alternative.

We report the cases of seven patients in which we detected MBs during cCT exam and we evaluated their functional significance using a stress-rest dynamic-CT MPI to decide the correct patient’s management. Three  patients showed reversible perfusion defect in the left anterior

descending (LAD) territory segments involved with MB and they were referred for treatment.

The remnants four patients with MB in the LAD revealed normal MPI and they were

conservatively managed. In all patients the results of the stress perfusion were completely overlapping, but the study with SPECT after anatomical evaluation required a longer process.

The cCT and stress-rest dynamic-CT MPI allowed to detect and to evaluate the functional

significance and to decide the management of MB in a “one-stop shop” exam.