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Non-invasive coronary angiography: the clinical value of multi-slice computed tomography in the assessment of patients with prior coronary bypass surgery

Evaluating grafts and native vessels

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Abstract

Background Contrast enhanced multi-slice computed tomography (MSCT) is the leading modality in non-invasive coronary angiography (CTA) today. We investigated MSCT based assessment of coronary artery bypass grafts (CABG) by analyzing assets and drawbacks of CTA in order to define demands on latest technology. Methods In a clinical setting 39 CABG patients (69.2 ± 1.4 years; male n = 36) underwent CTA (collimation 16 × 0.75 mm, contrast medium 100 ml; 320 mAs, 120 KV). Ninety-seven CABG (61 venous, 36 arterial grafts) were evaluated. A subgroup of 18 patients underwent additional invasive coronary angiography (CA). Results CTA for CABG assessment resulted in an overall sensitivity (sens.) of 100%, specificity (spec.) of 92.4% and positive and negative predictive values (PPV, NPV) of 60% and 100%, respectively. CABG anastomoses showed slightly inferior diagnostic accuracy than other CABG segments. Limitations in imaging quality caused 21% unevaluable segments of the CABG anastomoses. Evaluation of native vessel segments proximal and distal to the anastomoses resulted in a sens, spec, PPV and NPV of 57.5, 94.6, 92 and 67.3%, respectively. With 28.5% unevaluable segments, the native vessel segments showed serious limitations in imaging quality. Radiation exposure was 9.88 ± 3.20 mSv (9.69 ± 3.25 mSv male; 12.08 ± 1.35 mSv female). Conclusion 16-slice MSCT based CABG assessment offers sufficient diagnostic accuracy. However, focussing on the bypass anastomoses and the native revascularized coronary arteries, clinical value is limited.

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Authors and Affiliations

  1. Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    Helge von Kiedrowski, Marcus Wiemer, Olaf Oldenburg, Thomas Bitter, Khalid Mahmood, Dieter Horstkotte & Christoph Langer

  2. Institute of Radiology, Nuclear Medicine, and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany

    Krista Franzke, Rainer Preuss & Wolfram Burchert

  3. Department of Cardiology, Marienhospital, Herne, Gernany

    Thomas Butz

  4. Ruhr University, Bochum, Germany

    Helge von Kiedrowski, Marcus Wiemer, Krista Franzke, Rainer Preuss, Thomas Butz, Olaf Oldenburg, Thomas Bitter, Khalid Mahmood, Wolfram Burchert, Dieter Horstkotte & Christoph Langer

  5. Institute of Biometry, Hannover Medical School, Hannover, Germany

    Bernhard Vaske

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  1. Helge von Kiedrowski
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Correspondence to Christoph Langer.

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von Kiedrowski, H., Wiemer, M., Franzke, K. et al. Non-invasive coronary angiography: the clinical value of multi-slice computed tomography in the assessment of patients with prior coronary bypass surgery. Int J Cardiovasc Imaging 25, 161–170 (2009). https://doi.org/10.1007/s10554-008-9361-x

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  • DOI: https://doi.org/10.1007/s10554-008-9361-x

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