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Imaging and evaluation of coronary artery bypass graft patency by 16-slice multidetector computed tomography
Demetrios N Exarhos1, Asimina Baltouka, Constantinos Mihas
1Department of Computed Tomography and Magnetic Resonance Imaging, Evangelismos Hospital, Athens, Greece.
Insights
16-slice multidetector computed tomography (MDCT) effectively evaluates coronary artery bypass graft (CABG) patency. This non-invasive imaging method shows promising results as an alternative to traditional angiography.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Technology
Background:
- Coronary artery bypass grafts (CABGs) are crucial for managing coronary artery disease.
- Assessing CABG patency is vital for patient outcomes.
- Limitations exist in current diagnostic modalities for CABG evaluation.
Purpose of the Study:
- To evaluate the patency of coronary artery bypass grafts (CABGs).
- To assess the capabilities and limitations of 16-slice multidetector computed tomography (MDCT) for CABG assessment.
Main Methods:
- Retrospective study of 19 patients (44 CABGs) evaluated with 16-slice MDCT.
- Comparison of MDCT findings with invasive catheter coronary angiography.
- Utilized maximum intensity projections, multiplanar reformations, and volume rendering techniques.
Main Results:
- Of 44 grafts, 26 were patent, 13 not patent, and 5 stenotic.
- MDCT demonstrated differences in enhancement levels in stenotic grafts (>50%).
- Venous grafts were generally easier to assess than arterial grafts.
Conclusions:
- 16-slice MDCT is a fast, non-invasive method for evaluating CABG patency.
- MDCT is emerging as a viable alternative to invasive coronary angiography.
- The accuracy (sensitivity and specificity) of MDCT is dependent on technological advancements.
Introduction:
The purpose of this study was to evaluate the patency of coronary artery bypass grafts (CABGs) while assessing the capabilities and limitations of 16-slice multidetector computed tomography.
Methods:
We studied retrospectively 19 patients (13 men, 6 women), over an 18-month period. All patients had undergone CABG surgery 3 months to 7 years earlier. Two patients were examined on an emergency basis for chest pain and their CABGs were evaluated simultaneously. The number of CABGs in each patient ranged from one to three. A total of 44 grafts were assessed. All scans were performed by a 16-row multislice scanner (Toshiba Aquilion). Maximum intensity projections, multiplanar reformations, and volume rendering techniques were performed on a Vitrea workstation. All 19 patients also underwent invasive catheter coronary angiography for confirmation of their status.
Results:
Of the 44 grafts evaluated, 26 were classified as patent, 13 as not patent, and 5 as stenotic. In the bypass grafts with stenosis > or = 50% there was a difference in the mean level of enhancement before and after the stenosis (265.38 +/- 35.82 and 178.56 +/- 9.32, respectively). Seventeen arterial and 27 venous grafts were imaged. Of the 13 non-patent grafts, 8 were venous. In 3 cases of arterial grafts the distal anastomoses were not delineated. The assessment of venous grafts was easier because of their larger diameter and lack of surrounding clips. One case of a carotid-subclavian shunt with a distal anastomosis of the left internal mammary artery to the left anterior descending branch was reported. Sensitivity, specificity, positive and negative predictive values for stenosis were evaluated.
Conclusions:
Multidetector computed tomography is a fast and non-invasive modality for evaluating CABG patency that is gaining acceptance as an alternative method to invasive coronary angiography. Sensitivity and specificity are determined by the available and evolving technology.
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