Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

“…Although myocardial bridging has been held responsible for a variety of symptoms in individual cases, ranging from atypical chest pain to sudden death, thus far clinical studies have been unable to identify specific diagnostic features that allow a diagnosis of myocardial bridging without visualisation of the coronary arteries [5][6][7][8][9][10][11]. The diagnosis is usually established by chance in patients who are examined by CAG or CTCA for various reasons but not because they are suspected of having myocardial bridging.…”

“…Another often used division relates to the depth of the artery in the muscular wall, usually the interventricular septum. Bridging is categorised as deep or superficial using cutoff values of 1 mm [14] or 2 mm [6,17] for the thickness of the overlying myocardium. In addition superficial bridging may be subdivided into cases with full or partial encasement [14].…”

Attenuation Drop of Intra-Mural Coronary Segment Observed at Diastolic Phase of Coronary CT Angiography Predicts Significant Systolic Compression of Myocardial Bridge

“…However, it is neither reasonable nor practical to use such an invasive imaging modality merely to quantify MB compression in patients without coronary artery disease. Coronary CTA has been proven to be more sensitive than ICA for detection of MB due to its ability to visualize the intra-mural course of coronary arteries [12][13][14][15][16]. However, determination of compression extent requires artifact-free images of end-systolic phases, which are sometimes not available with low-dose prospective acquisition [12].…”

“…MB lesions were divided into three subgroups according to the extent of systolic compression as determined by end-systolic phases of CTA imThe MB detection rate varies significantly between the different imaging modalities of coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA). Coronary CTA usually reveals a much higher incidence of MB than ICA [12][13][14][15][16] due to the capability of coronary CTA to detect MB without the presence of systolic compression. The clinical significance of myocardial bridging lies in related regional hemodynamic changes caused by dynamic compression.…”

Myocardial Bridging

“…[32][33][34][35][36][37] With cardiac computed tomography, the mural course of the vessel with the overlying myocardial fibers can be visualized, the length and depth of the tunneled segment can be measured, and the extent of proximal atherosclerosis can be quantified. Compared with intravascular ultrasound, a sensitivity of 93% and specificity of 100% were reported in 30 patients with and 21 patients without myocardial bridging.…”