title: Detection of vein graft disease using high-resolution magnetic resonance angiography.
abstract: BACKGROUND
  The application of previous magnetic resonance (MR) angiography techniques has enabled noninvasive differentiation between patent and occluded coronary artery bypass grafts. However, the detection of graft stenosis remains difficult. The purpose of our study was to determine the accuracy of high-resolution navigator-gated 3-dimensional (3-D) MR angiography in detecting vein graft disease. Methods and Results- MR angiography was performed in addition to coronary angiography with quantitative coronary analysis in 56 vein grafts from 38 patients (mean age 66.6+/-9.3 years), who presented with recurrent chest pain after bypass surgery. Eighteen grafts showed a luminal stenosis >/=50%, 11 grafts a stenosis >/=70%, and 6 grafts were occluded. All MR angiograms were evaluated independently by 2 blinded observers, who scored the presence of graft occlusion and graft stenosis >/=50% and >/=70% with a confidence level of 1 to 10. MR image quality was judged as insufficient in 6 grafts and these were excluded. Receiver-operator characteristic analysis revealed an area under the curve of 0.89 and 0.89 for identifying graft occlusion, 0.81 and 0.87 for stenosis >/=50%, and 0.82 and 0.79 for stenosis >/=70% for the 2 observers, respectively. Interobserver agreement in assessing graft occlusion and stenosis >/=50% and >/=70% was 94% (kappa=0.74, r=0.81), 72% (kappa=0.40, r=0.66), and 82% (kappa=0.53, r=0.72), respectively.
  
  
  CONCLUSIONS
  High-resolution navigator-gated 3-D MR angiography allows not only good differentiation between patent and occluded vein grafts but also the assessment of vein graft disease with a fair diagnostic accuracy. This approach offers perspective as a noninvasive diagnostic tool for patients who present with recurrent chest pain after vein graft surgery.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Langerak
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Patrik
authors.initials: P
authors.lastname: Kunz
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van Der Wall
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014654:Vascular Patency; D014680:Veins / Q000502:physiology / Q000637:transplantation*