Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery Bypass Grafts - Update 2017
Florian Jungmann1, Tilman Emrich1, Peter Mildenberger1
1Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
Insights
Multidetector computed tomography angiography (MD-CTA) is a reliable, noninvasive method for assessing coronary artery bypass grafts (CABG). Recent technical advances significantly reduce radiation dose while maintaining high diagnostic accuracy for graft patency.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Technology
Background:
- Coronary artery bypass grafting (CABG) remains a crucial treatment for advanced coronary artery disease.
- Assessing the patency and stenosis of CABG is vital for patient outcomes.
- Multidetector computed tomography angiography (MD-CTA) is increasingly utilized for post-CABG imaging.
Purpose of the Study:
- To evaluate the current role and diagnostic performance of MD-CTA in imaging patients after CABG surgery.
- To review the literature on MD-CTA for CABG assessment using 64-slice MD-CT scanners and beyond.
- To analyze the accuracy of MD-CTA compared to invasive coronary angiography (ICA) for graft evaluation.
Main Methods:
- Systematic review of 13 reports published between 2007 and 2016.
- Inclusion of studies comparing ECG-gated MD-CTA with ICA as the reference standard.
- Analysis of data from 1002 patients and 2521 bypass grafts, focusing on true/false positive/negative results.
Main Results:
- MD-CTA demonstrated high diagnostic accuracy for graft patency and detecting >50% stenosis (sensitivity 97.2%, specificity 97.5%).
- Negative and positive predictive values were 93.6% and 99%, respectively.
- Radiation dose exposure decreased to as low as 2.4 mSv with advanced techniques like prospective ECG-gating.
Conclusions:
- ECG-gated MD-CTA is a fast, reliable, and noninvasive method for post-CABG assessment.
- Modern CT scanner generations offer significant radiation dose reduction without compromising diagnostic accuracy.
- MD-CTA is a valuable tool for evaluating coronary artery bypass grafts.
Background:
Coronary artery bypass grafting (CABG) is still an important therapeutic approach in the treatment especially of advanced coronary artery disease. In this study, we elucidate the current role of multidetector computed tomography angiography (MD-CTA) in imaging patients after CABG surgery.
Method:
This study is based on recent reports in the literature (2007 - 2016) on imaging of CABG using 64-slice MD-CT scanners and beyond. We included 13 reports that compared ECG-gated MD-CTA with conventional invasive coronary angiography (ICA) as the reference standard for the assessment of graft patency and for the detection of > 50 % stenoses. These studies had to provide absolute values for true-positive, true-negative, false-positive and false-negative results or at least allow calculation of these numbers. In total, 1002 patients with 2521 bypass grafts were the basis for this review.
Results And Conclusion:
The sensitivity and specificity for the assessment of graft patency or the detection of > 50 % graft stenosis were 97.2 % and 97.5 %, respectively. The negative and positive predictive values were 93.6 % and 99 %, respectively. By using prospective ECG-gating and an increasing pitch factor, the radiation dose exposure declined to 2.4 mSv in the latest reports. ECG-gated MD-CTA provides a fast and reliable, noninvasive method for assessing patients after CABG. The most substantial benefit of the newest CT scanner generations is a remarkable reduction of radiation dose exposure while maintaining a still excellent diagnostic accuracy during recent years.
Key Points:
· MD-CTA using 64-slice MDCT scanners and beyond is a reliable, noninvasive method for evaluating CABGs.. · Technical advances such as prospective ECG-gating, iterative reconstruction algorithms and high-pitch scanning lead to a remarkable drop-down in radiation dose exposures as low as 2.4 mSv.. · Despite significant dose reductions, MD-CTA could maintain a high diagnostic accuracy in evaluating CABGs in recent years..
Citation Format:
· Jungmann F, Emrich T, Mildenberger P et al. Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery Bypass Grafts - Update 2017. Fortschr Röntgenstr 2018; 190: 237 - 249.
More Related Videos
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:21Imaging Studies for Cardiovascular System IV: CMRI