{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:41Z","timestamp":1760060741313,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Imaging"],"abstract":"<jats:p>Myocardial bridging (MB) is a congenital coronary anomaly whose clinical impact remains controversial. Coronary computed tomography angiography (CCTA) combined with CT myocardial perfusion imaging (CT-MPI) enables a comprehensive anatomical and functional assessment of MB. This study aimed to investigate whether specific high-risk anatomical features of MB are independently associated with myocardial hypoperfusion, using combined CCTA and CT-MPI. We retrospectively analyzed 81 patients with MB showing high-risk anatomical features (depth \u2265 2.0 mm and length \u2265 25 mm) identified by CCTA, all of whom underwent stress dynamic CT-MPI between May 2022 and December 2025. Patients were classified according to the presence or absence of hypoperfusion in MB-related myocardial segments. Clinical and anatomical variables were compared between two groups using non-parametric tests, and multivariable logistic regression was performed to identify independent predictors of hypoperfusion. Among the 81 patients (mean age, 59.3 \u00b1 11.7 years; 54 males), 26 (32.1%) demonstrated perfusion defects. All MBs were located in the left anterior descending artery (LAD). No significant differences were observed in clinical variables between groups. Bridges associated with hypoperfusion were significantly deeper (p &lt; 0.001) and were more frequently located in the mid-LAD (73.1% vs. 38.2%, p = 0.01). In multivariable analysis, bridge depth and mid-LAD location remained independent predictors of hypoperfusion. In patients with MB, greater depth and mid-LAD location are independently associated with myocardial hypoperfusion. The combined use of CCTA and CT-MPI may enhance risk stratification and help guide clinical decision-making in this patient population.<\/jats:p>","DOI":"10.3390\/jimaging11090324","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T10:05:17Z","timestamp":1758535517000},"page":"324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined CCTA and Stress CTP for Anatomical and Functional Assessment of Myocardial Bridges"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2993-5718","authenticated-orcid":false,"given":"Marco","family":"Fogante","sequence":"first","affiliation":[{"name":"Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy"}]},{"given":"Paolo Esposto","family":"Pirani","sequence":"additional","affiliation":[{"name":"Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy"}]},{"given":"Fatjon","family":"Cela","sequence":"additional","affiliation":[{"name":"Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6724-9001","authenticated-orcid":false,"given":"Enrico","family":"Paolini","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Cardiac Care Unit, Cardiovascular Department, University Hospital of Marche, 60126 Ancona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0156-8393","authenticated-orcid":false,"given":"Liliana","family":"Balardi","sequence":"additional","affiliation":[{"name":"Health Professions Area, Diagnostic Technical Area, University Hospital of Marche, 60126 Ancona, Italy"}]},{"given":"Nicol\u00f2","family":"Schicchi","sequence":"additional","affiliation":[{"name":"Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy"},{"name":"Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1002\/ca.23697","article-title":"Myocardial Bridges: A Meta-Analysis","volume":"34","author":"Roberts","year":"2021","journal-title":"Clin. Anat."},{"key":"ref_2","first-page":"1687.E13","article-title":"Myocardial Infarction Caused by Accelerated Plaque Formation Related to Myocardial Bridge in a Young Man","volume":"34","author":"Kikuchi","year":"2018","journal-title":"Can. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1016\/j.jacc.2021.09.859","article-title":"Myocardial Bridging: Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review","volume":"78","author":"Sternheim","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"I61","DOI":"10.1093\/eurheartjsupp\/suac075","article-title":"The Myocardial Bridge: Incidence, Diagnosis, and Prognosis of a Pathology of Uncertain Clinical Significance","volume":"24","author":"Santucci","year":"2022","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.4244\/EIJ-D-18-00920","article-title":"Prevalence of Myocardial Bridging Associated with Coronary Endothelial Dysfunction in Patients with Chest Pain and Non-Obstructive Coronary Artery Disease","volume":"15","author":"Sara","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e8277","DOI":"10.1097\/MD.0000000000008277","article-title":"Myocardial CT Perfusion Imaging for Pre- and Postoperative Evaluation of Myocardial Ischemia in a Patient with Myocardial Bridging: A Case Report","volume":"96","author":"Lim","year":"2017","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1016\/j.jacc.2016.09.973","article-title":"Left Anterior Descending Artery Myocardial Bridging: A Clinical Approach","volume":"68","author":"Tarantini","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","first-page":"229","article-title":"Stress-Rest Dynamic-CT Myocardial Perfusion Imaging in the Management of Myocardial Bridging: A \u201cOne-Stop Shop\u201d Exam","volume":"28","author":"Schicchi","year":"2023","journal-title":"J. Cardiol. Cases"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1007\/s12350-020-02293-z","article-title":"Functional Significance of Intermediate Coronary Stenosis in Patients with Single-Vessel Coronary Artery Disease: A Comparison of Dynamic SPECT Coronary Flow Reserve with Intracoronary Pressure-Derived Fractional Flow Reserve (FFR)","volume":"29","author":"Li","year":"2022","journal-title":"J. Nucl. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Seitun, S., De Lorenzi, C., Cademartiri, F., Buscaglia, A., Travaglio, N., Balbi, M., and Bezante, G.P. (2018). CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging. BioMed Res. Int., 2018.","DOI":"10.1155\/2018\/7295460"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1007\/s00330-015-3604-8","article-title":"Patient Satisfaction with Coronary CT Angiography, Myocardial CT Perfusion, Myocardial Perfusion MRI, SPECT Myocardial Perfusion Imaging and Conventional Coronary Angiography","volume":"25","author":"Feger","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fogante, M., Paolini, E., Cela, F., Esposto Pirani, P., Balardi, L., Perna, G.P., and Schicchi, N. (2025). Feasibility, Added Value, and Radiation Dose of Combined Coronary CT Angiography and Stress Dynamic CT Myocardial Perfusion Imaging in Moderate Coronary Artery Disease: A Real-World Study. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12070241"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1148\/radiol.2019181409","article-title":"Patient Preferences for Coronary CT Angiography with Stress Perfusion, SPECT, or Invasive Coronary Angiography","volume":"291","author":"Minhas","year":"2019","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.amjcard.2023.08.040","article-title":"Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic Assessment of Myocardial Bridging from the CORE320 Study: 5-Year Follow-Up","volume":"207","author":"Gannon","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_15","first-page":"654","article-title":"Impact of Myocardial Bridge-Mural Coronary Artery on Myocardial Blood Supply","volume":"38","author":"Zhao","year":"2016","journal-title":"Acta Acad. Med. Sin."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.jcmg.2015.02.013","article-title":"Myocardial Bridges: Lessons in Clinical Coronary Pathophysiology","volume":"8","author":"Gould","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1179546819846493","DOI":"10.1177\/1179546819846493","article-title":"The Myocardial Bridge: Potential Influences on the Coronary Artery Vasculature","volume":"13","author":"Teragawa","year":"2019","journal-title":"Clin. Med. Insights Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.3348\/kjr.2021.0043","article-title":"CT Fractional Flow Reserve for the Diagnosis of Myocardial Bridging-Related Ischemia: A Study Using Dynamic CT Myocardial Perfusion Imaging as a Reference Standard","volume":"22","author":"Yu","year":"2021","journal-title":"Korean J. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.jcin.2018.07.004","article-title":"Low Coronary Wall Shear Stress Is Associated With Severe Endothelial Dysfunction in Patients With Nonobstructive Coronary Artery Disease","volume":"11","author":"Kumar","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1016\/j.jacc.2014.01.049","article-title":"Myocardial Bridging: Contemporary Understanding of Pathophysiology with Implications for Diagnostic and Therapeutic Strategies","volume":"63","author":"Corban","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s12350-011-9406-8","article-title":"Myocardial Perfusion GSPECT Imaging in Patients with Myocardial Bridging","volume":"18","author":"Gawor","year":"2011","journal-title":"J. Nucl. Cardiol."}],"container-title":["Journal of Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2313-433X\/11\/9\/324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:43Z","timestamp":1760035603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2313-433X\/11\/9\/324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,21]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jimaging11090324"],"URL":"https:\/\/doi.org\/10.3390\/jimaging11090324","relation":{},"ISSN":["2313-433X"],"issn-type":[{"type":"electronic","value":"2313-433X"}],"subject":[],"published":{"date-parts":[[2025,9,21]]}}}