title: Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease.
abstract: BACKGROUND
  Selective coronary angiography (SCA) is the standard invasive procedure for diagnosis in patients eligible for coronary artery bypass grafting (CABG). A recently developed, highly sensitive multidetector computed tomography (MDCT) scan holds promise to be of almost comparable quality and predictiveness. We examined a blinded series of preoperative patients who were admitted to hospital for conventional and minimally invasive CABG procedures. Patients underwent CT scans in addition to SCA; findings were compared regarding location and degree of coronary artery stenosis.
  
  
  METHODS
  Twenty patients underwent electrocardiogram-gated helical CT scanning. Images with 250 ms effective exposure time were reconstructed with retrospective electrocardiogram gating. Location and degree of coronary stenoses were described and compared with findings of SCA. The study was limited to patients with a heart rate of less than 70 beats per minute and who had the ability to hold their breath for 20 to 30 seconds.
  
  
  RESULTS
  Coronary arteries were clearly displayed by MDCT. Compared with SCA, sensitivity was 92%, specificity 84%, and negative predicted value 89% for significant stenosis (more than 50%). Early forms of atherosclerotic changes were even clearer on MDCT. In addition, the CT examination allowed differentiation of calcified and fatty or fibrous stenoses.
  
  
  CONCLUSIONS
  Multidetector CT scanning is an effective noninvasive technique for the diagnosis of coronary artery disease. In selected patients, MDCT scanning might be able to replace SCA as a preoperative test for CABG procedures. The intrathoracic situs can be clearly exposed as it is important for the planning of minimally invasive CABG procedures.
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany. treede@uke.uni-hamburg.de
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*