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Non-invasive imaging of vein grafts with multislice computed tomography

Nicht-invasive Bildgebung von venösen koronaren Bypässen mittels Multislice Computertomographie

Zusammenfassung

GRUNDLAGEN: Die Einführung von Multislice Computertomographie (MSCT)-Scannern im Jahre 1999 eröffnete neue Horizonte im Bereich der nicht-invasiven kardialen Bildgebung. So ermöglichen 16- und 64-zeilen MSCT-Scanner eine nicht-invasive Beurteilung der Durchgängigkeit von koronaren Bypässen. METHODIK: Dieser Review-Artikel beschreibt die technischen Grundlagen der MSCT-Angiographie, erläutert die radiologische Darstellung von venösen Bypässen und deren pathologische Befunde und gibt einen Überblick über rezente Literatur. ERGEBNISSE: Die Multislice Computertomographie (MSCT)-Angiographie erlaubt eine Beurteilung der Durchgängigkeit von koronaren Bypässen. Komplette Verschlüsse können mit einer sehr hohen diagnostischen Treffsicherheit erkannt werden. Die Quanitifizierung des Stenosegrades von distalen Anastomosenstenosen ist jedoch mittels MSCT im Vergleich zur invasiven Angiographie aufgrund geringerer Auflösung, und/oder durch die Präsenz von metallischen Clips limitiert. Eine degenerative venöse Bypassgefässerkrankung kann mittels MSCT anhand der Darstellung von nicht-verkalkten und verkalkten Plaques jedoch schon in Frühstadium diagnostiziert werden. SCHLUSSFOLGERUNGEN: Als nicht-invasive Methode eignet sich die Multislice Computertomographie (MSCT)-Angiographie in der klinischen Praxis zum Ausschluss von kompletten koronaren Bypassverschlüssen in Patienten, in welchen eine invasive Angiographie klinisch nicht primär indiziert ist (z.B. atypische Angina Pectoris, nicht-beurteilbare oder grenzwertig-pathologische Ergometrie), oder auch für Patienten mit hohem Eingriffsrisiko. Weiteres bietet sich die MSCT für die Evaluierung von Patienten mit unklaren post-operativen Thoraxschmerzen nach Bypassoperation an, da simultan auch extra-kardiale Pathologien des Thorax (Hämatom, Abszess, Pneumothorax, Infektion oder Dehiszenz des Sternums, Pulmonalarterienembolie, etc.) erfasst werden können.

Summary

BACKGROUND: Multislice computed tomography (MSCT)-angiography is a new, emerging cardiovascular imaging modality. METHODS: This article reviews the "essentials" of venous bypass graft imaging by using MSCT, including the basic technical principles of MSCT, the radiological appearance of vein grafts and currently available literature. RESULTS: Multislice computed tomography (MSCT)-angiography allows an accurate evaluation of coronary bypass graft patency. Complete graft occlusion can be detected with a high diagnostic accuracy. However, detection and quantification of distal anastomosis stenosis is limited by MSCT when compared with invasive angiography due to limited spatial resolution and/or in the presence of metallic surgical clips. Vein graft disease can be diagnosed at early stages by imaging of non-calcified or calcifying plaques. CONCLUSIONS: Non-invasive multislice computed tomography (MSCT)-angiography can be used as "gatekeeper" in patients in whom invasive angiography is not the modality of first choice (e.g. atypical angina pectoris; inconclusive or equivocal or borderline positive ECG-stress test) or in patients who are at high risk for invasive catheter intervention in order to determine bypass graft patency. MSCT can be also applied for the evaluation of non-specific post-operative chest pain in patients after coronary bypass surgery, because extra-cardiac pathologies such as haematoma, abscess formation, pneumothorax, pulmonary embolism or sternal bone infections can be assessed simultaneously.

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Correspondence to Gudrun M. Feuchtner.

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Feuchtner, G. Non-invasive imaging of vein grafts with multislice computed tomography. Eur Surg 39, 105–110 (2007). https://doi.org/10.1007/s10353-007-0321-9

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  • DOI: https://doi.org/10.1007/s10353-007-0321-9

Schlüsselwörter

  • Multislice Computertomographie
  • Koronare Bypasschirurgie

Keywords

  • Multislice computed tomography
  • Coronary artery bypass graft (CABG) surgery