Non-invasive evaluation of coronary artery bypass grafts using 16-row multi-slice computed tomography with 188 ms...

Cardiac multi-slice computed tomography (MSCT) scanners permit visualization of the coronary arteries and coronary artery bypass grafts. The latest MSCT generation with true 16-detector slices (Sensation 16 Speed 4 D, Siemens, Forchheim, Germany) provides improved temporal and spatial resolution, as well as significantly reduced scan time. To assess, whether this technical improvement has also an impact on image quality and accuracy of MSCT diagnosis in patients with previous coronary artery bypass graft (CABG) surgery the following study was conducted.

Thirteen consecutive patients (pts) (10 male, 3 female, mean age 62 +/- 6.4 [55-73] years, heart rate 68 +/- 11 [52-88] bpm) and a total number of 43 coronary bypass grafts (11 arterial, 32 venous grafts) were examined by MSCT (gantry rotation time 375 ms). In addition to the analysis of coronary bypass grafts, 13 coronary segments (sgts) were evaluated in each patient (n = 169 sgts). MSCT results were compared with coronary angiography.

Forty-one of 43 bypass grafts (95%) were analyzable by MSCT. In conventional angiography 16 of 43 (37%) grafts were occluded. Sixteen of them were correctly diagnosed by MSCT (sensitivity 100%). One graft showed a 50% anastomosis stenosis which was also detected. Twenty-five of 27 grafts without severe lesion showed no significant stenosis in MSCT (specificity 93%, positive predictive value (PPV) 89%, negative predictive value (NPV) 100%). Ninety of 108 (83%) high-grade stenosis (>70%) of the native coronary vessels were correctly detected (sensitivity 83%, PPV 78%). From the 61 sgts without high grade stenosis 36 were correctly classified (specificity 59%, NPV 67%). If sgts number 8, 9 and 10, which are normally not target for revascularization, are excluded sensitivity rises to 89%, specificity to 71%, PPV to 87% and NPV to 75%. The correct clinical diagnosis (absence or presence of a high grade stenosis of at least one bypass graft) was achieved in all patients.

True 16-slice MSCT with faster gantry rotation time allows detection of lesions in coronary artery bypass grafts with high sensitivity and specificity. The evaluation of native vessels in pts with known CAD remains a diagnostic challenge. However, the correct clinical diagnosis was achieved in all pts. MSCT is a non-invasive tool to assess coronary artery bypass grafts.