Non-invasive evaluation of coronary artery bypass grafts using 16-row multi-slice computed tomography with 188 ms temporal resolution
Introduction
Coronary artery bypass graft (CABG) surgery is usually performed in patients (pts) with advanced coronary artery disease (CAD). Early graft occlusion is described in up to 23% of all pts [1], and a large number of all pts develop angina pectoris within the initial 3 months. For some years, multi-slice computed tomography (MSCT) is a tool for non-invasive visualization of the coronary arteries and coronary artery bypass grafts [2], [3], [4], [5]. However, at present, the gold standard for direct visualization of coronary artery vessels is still invasive X-ray coronary angiography due to the limited spatial and temporal resolution of former CT scanners. Moreover, breathing artifacts due to the scan time can cause poor distal vessel segment and side branch visualization.
The aim of this study was to investigate whether new true 16-slice MSCT which provides better temporal and spatial resolution as well as significantly reduced scan time will have an impact on the sensitivity and specificity in detection of CABG occlusion or stenosis. Moreover the accuracy of stenosis detection in the native coronary vessels should be evaluated.
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Patients and study protocol
Thirteen consecutive pts (10 male, 3 female, mean age 62 ± 6.4 [55–73] years, heart rate 68 ± 11 [52–88] bpm) with history of CABG were included. All pts were scheduled for invasive coronary angiography due to recurrence of angina pectoris. A total number of 43 coronary artery bypass grafts (11 arterial grafts, 32 venous grafts) were examined by cardiac MSCT. The study protocol was approved by the local ethics committee. All pts gave informed consent before inclusion in the study. Clinical
Study group
The study group consisted of 13 consecutive pts (10 male, 3 female) with prior CABG surgery scheduled for conventional coronary angiography due to recurrent angina pectoris. The clinical characteristics are summarized in Table 1.
Mean heart rate after β-blockade was 68 ± 11 [52–88] beats per min. Mean calcium score in our cohort was 1860 ± 1225 [391–4931].
Coronary artery bypass grafts
Five of 43 (11%) scanned grafts showed excellent image quality. Twenty of 43 (47%) grafts could be visualized with good image quality. Relevant
Discussion
The most important findings of the present study are as follows: (1) Coronary artery bypass grafts can be evaluated with high sensitivity and specificity using 16-row multi-slice computed tomography wit 188 ms temporal resolution. (2) With the new 16-row scanner diagnostic image quality was achieved in 41/43 bypass grafts (95%). (3) Despite impaired image quality of the native vessels the correct clinical diagnosis could be achieved in all pts.
At the beginning of MSCT era diagnostic value of
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Pitfalls and pearls in the imaging of cardiac ischemia
2022, Seminars in Ultrasound, CT and MRICitation Excerpt :A study assessing CCTA in patients with a history of CABG showed a sensitivity of 86% and specificity of 76% for the detection of stenoses in the native coronary arteries21 showing a limitation of this modality in this patient population. Accurate assessment of venous bypass graft(s) for stenosis and occlusion can be reliably performed with CCTA given the large diameter with previous studies reporting an accuracy near 100%.22 However, CCTA of the internal mammary artery graft(s) is challenging because of their small diameter and artifacts from the metallic surgical clips along those grafts.21
Coronary Artery Computed Tomography Angiography
2010, Clinical Nuclear Cardiology: State of the Art and Future DirectionsCoronary artery computed tomography angiography
2010, Clinical Nuclear CardiologyCurrent indications for cardiac CT
2009, Archives of Cardiovascular Diseases SupplementsCurrent indications for cardiac CT
2009, Journal de Radiologie
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Both authors contributed equally.