Coronary artery bypass graft (CABG) patency: Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography
Coronary artery bypass graft (CABG) patency: Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography
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DOI：
10.1016/j.ejrad.2005.12.018
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发表时间：
2006-03-01
影响因子：
3.3
通讯作者：
Achenbach, S
中科院分区：
文献类型：
--
作者：
Anders, K;Baum, U;Achenbach, S
目的：研究16层多层螺旋CT（MDCT）显示冠状动脉旁路移植术（CABG）通畅性和检测旁路狭窄的能力。材料和方法：32例患者，94个移植物采用16层螺旋CT，采用12 x 0.75 mm层厚扫描方案，对20例乳腺动脉移植物，74例静脉移植物进行了研究（音高0.3），420 ms旋转时间和同步心电图（ECG）配准。根据单独确定的造影剂通过时间延迟注射100毫升碘化造影剂。心率高于60 bpm的患者口服β受体阻滞剂，根据心率采用心电门控半扫描重建或多段重建算法重建断层图像，层宽为1.0 mm（增量为0.5 mm）。由两名独立观察员评价旁路移植物的通畅性和横截面图像上直径缩小>= 50%的狭窄、多平面重建和最大强度投影。结果：16层螺旋CT冠状动脉造影（CTA）诊断冠状动脉旁路移植物闭塞的敏感性为100%（28/28），特异性为98%（64/65），与有创冠状动脉造影（CTA）结果比较，发现冠状动脉旁路移植物闭塞或管腔缩小≥ 50%的狭窄。78%（观察者1）和84%（观察者2）的所有通畅移植物可评价是否存在狭窄。在40例旁路移植物中的34例（观察者1）和43例旁路移植物中的38例（观察者2）中，高度狭窄被正确排除（特异性85%和88%，灵敏度80%和82%）。然而，如果排除所有不可评估的移植物/移植物吻合或相关移植物狭窄的患者，只有8/32例患者（25%）具有完全诊断性的"阴性"移植物CTA。根据Kappa统计，观察者之间关于闭塞和相关狭窄的一致性分别为1.0和0.93。结论：亚毫米空间分辨率的16层冠状动脉CTA和口服β受体阻滞剂的术前用药允许无创评估冠状动脉旁路移植术，减少不可评估的移植物节段数量。然而，基于患者的分析表明，只有相对较少的患者（"阴性"和完全可评价的移植物CTA）真正受益于无创检查，可以避免有创血管造影。(C)2006爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: To investigate the ability of 16-slice multidetector-row computed tomography (MDCT) to visualize coronary artery bypass graft (CABG) patency and to detect bypass stenoses.Materials and methods: Thirty-two patients with 94 grafts (20 mammary artery grafts, 74 venous grafts) were investigated by 16-slice MDCT using a scan protocol with 12 x 0.75 mm slice collimation (pitch 0.3), 420 ms rotation time and simultaneous electrocardiogram (ECG)registration. One hundred milliliters iodinated contrast agent were injected with a delay according to the individually determined contrast agent transit time. Patients with heart rates above 60 bpm received oral beta-blockade.Cross-sectional images with a slice width of 1.0 mm (0.5 mm increment) were reconstructed using an ECG-gated half-scan reconstruction or a multisegment reconstruction algorithm depending on the heart rate. Bypass grafts were evaluated concerning patency and presence of stenoses >= 50% diameter reduction on cross-sectional images, multiplanar reformations and maximum intensity projections by two independent observers. Results were compared to coronary bypass angiography.Results: Sixteen-slice MDCT results were compared to those of invasive coronary angiography concerning absence or presence of bypass graft occlusion or relevant stenosis >= 50% lumen reduction.Coronary CT angiography (CTA) permitted detection of bypass occlusion with 100% sensitivity (28/28) and 98% specificity (64/65). Seventy-eight percent (observer 1) and 84% (observer 2) of all patent grafts were found to be evaluable concerning presence or absence of stenosis. In 34 of 40 (observer 1) and 38 of 43 (observer 2) bypass grafts, high-grade stenoses were correctly ruled out (specificity 85% versus 88%, sensitivity 80% and 82%). Yet, if all patients with either unevaluable grafts/graft anastomosis or relevant graft stenosis were excluded, only 8/32 patients (25%) had fully diagnostic "negative" graft-CTA.According to Kappa statistics, agreement between the observers was 1.0 and 0.93 concerning occlusion and relevant stenosis, respectively. Conclusion: Sixteen-slice coronary CTA with sub-millimeter spatial resolution and premedication with oral beta-blockade permits noninvasive assessment of coronary artery bypass grafts with decreasing numbers of unevaluable graft segments. However, patient-based analysis reveals that only a relatively small number of patients ("negative" and completely evaluable graft-CTA) truly profits from noninvasive work-up and could be spared invasive angiography. (C) 2006 Elsevier Ireland Ltd. All rights reserved.