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Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography
Emma S Houslay1, Tristan Lawton, Anshuman Sengupta
1Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. eshouslay@hotmail.com
Insights
Computed tomography angiography (CTA) accurately assesses coronary artery bypass graft patency non-invasively. While effective, CTA involves a higher radiation dose compared to traditional coronary angiography.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Radiology
Background:
- Coronary artery bypass grafting (CABG) requires graft patency assessment.
- Invasive coronary angiography poses risks like myocardial infarction and stroke.
- Non-invasive alternatives are sought to evaluate bypass vessels.
Purpose of the Study:
- To evaluate computed tomography (CT) as a non-invasive method for assessing coronary artery bypass graft patency.
- To compare the diagnostic accuracy of CT angiography with conventional coronary angiography.
Main Methods:
- Fifty patients undergoing coronary angiography for CABG assessment were included.
- Contrast-enhanced CT angiography was performed using a 16-slice scanner.
- Image analysis included multiplanar and 3D reconstructions; sensitivity, specificity, and accuracy were calculated.
Main Results:
- CT demonstrated 100% specificity and 92.8% sensitivity for graft patency detection.
- Overall accuracy was 94.8% with strong agreement (kappa=0.9) with conventional methods.
- Pooled analysis of 932 grafts across eight studies showed 97% accuracy for CT.
Conclusions:
- Computed tomography angiography is an accurate and rapid non-invasive tool for evaluating coronary artery bypass graft patency.
- The method offers a viable alternative to invasive angiography for graft assessment.
- Increased radiation dose is a consideration when using CT for this purpose.
Background:
Invasive coronary angiography is the gold standard means of imaging bypass vessels and carries a small but potentially serious risk of local vascular complications, including myocardial infarction, stroke and death. We evaluated computed tomography as a non-invasive means of assessing graft patency.
Methods:
Fifty patients with previous coronary artery bypass surgery who were listed for diagnostic coronary angiography underwent contrast enhanced computed tomography angiography using a 16-slice computed tomography scanner. Images were retrospectively gated to the electrocardiogram and two dimensional axial, multiplanar and three dimensional reconstructions acquired. Sensitivity, specificity, positive and negative predictive value, accuracy and level of agreement for detection of graft patency by multidetector computed tomography.
Results:
A total of 116 grafts were suitable for analysis. The specificity of CT for the detection of graft patency was 100%, with a sensitivity of 92.8%, positive predictive value 100%, negative predictive value 85.8% and an accuracy of 94.8%. The kappa value of agreement between the two means of measuring graft patency was 0.9. Mean radiation dose was 9.0 +/- 7.2 mSv for coronary angiography and 18.5 +/- 4 mSv for computed tomography. Pooled analysis of eight studies, incorporating 932 grafts, confirmed a 97% accuracy for the detection of graft patency by multidetector computed tomography.
Conclusion:
Computed tomography is an accurate, rapid and non-invasive method of assessing coronary artery bypass graft patency. However, this was achieved at the expense of an increase in radiation dose.
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