Detection of Anatomical Variations and Pathological Findings of Coronary Arteries Using CT Coronary Angiography (CTCA) in Sudanese Adults in a Tertiary Hospital

Abstract

BACKGROUND: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide. Traditional diagnostic methods relied on electrocardiography (ECG) and cardiac enzyme testing, with limited accuracy. With advances in imaging, ECG-gated CT coronary angiography (CTCA) has become a reliable, non-invasive tool for risk assessment and diagnosis of coronary artery disease (CAD). METHODS: A retrospective, cross-sectional study was conducted in the radiology department of Ahmed Gasim Hospital, Sudan. Data were extracted from 95 CTCA reports between January 2020 and June 2022 using a structured 14-item questionnaire. Patient demographics, calcium scores, coronary stenosis/occlusion, congenital anomalies, and anatomical variations were analysed. RESULTS: The mean patient age was 51 years (range: 20-87), with male patients comprising 56.8%. Most patients (63.2%) had a calcium score of zero. Among positive scores, 17.9% were <100, 13.7% were 100-500, 2.1% were 500-1000, and 3.2% were >1000. The left anterior descending artery (LAD) was the most frequently affected artery (20.0%), followed by the right coronary artery (RCA) (13.7%), and left circumflex artery (LCX) (10.5%); left main coronary artery (LMCA) showed no stenosis. Proximal severe stenosis was the predominant pattern. Congenital anomalies were detected in six patients (6.3%), most commonly myocardial bridging. Anatomical variations were also found in five patients (5.3%), with malignant RCA origin from the left cusp being the most frequent. CONCLUSION: CTCA effectively identified calcium scores, stenosis, congenital anomalies, and anatomical variations in Sudanese patients. Findings highlight a predominance of proximal severe stenosis in LAD and RCA, with myocardial bridging as the most frequent congenital anomaly and malignant RCA origin as the most common variation.