title: Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting.
abstract: OBJECTIVE
  To assess multi-detector row spiral computed tomography (CT) for preoperative evaluation of patients undergoing totally endoscopic coronary artery bypass grafting and to correlate the data with coronary angiographic and intraoperative findings.
  
  
  METHODS
  Thirty-six patients preoperatively underwent multi-detector row CT (4 x 1-mm collimation, pitch of 1.5, 500-msec rotation time, retrospective electrocardiographic gating, 1.25-mm effective section thickness) and coronary angiography. Assessment criteria for both techniques were visibility and cardiac course of coronary arteries, localization and degree of stenoses, composition of atherosclerotic plaques, and vascular diameter at anastomosis site. Site for distal bypass anastomosis was recommended. Results at multi-detector row CT were calculated relative to results at coronary angiography and surgery.
  
  
  RESULTS
  Multi-detector row CT properly displayed 79.4% (154 of 194) of all surgical relevant coronary segments and 80.4% (434 of 540) of all coronary segments. For coronary angiography, ratios of 88.7% (172 of 194) and 94.6% (511 of 540), respectively, were observed. For detection of calcified plaques, multi-detector row CT results exceeded those at coronary angiography by a difference of 17% (18 of 18 [100%] compared with 15 of 18 [83%]). Hemodynamically relevant stenoses were identified with multi-detector row CT in 76% (42 of 55) of cases. Bridging of coronary segments through either myocardium (four of five) or epicardial fat (two of three) was better identified at multi-detector row CT than it was at coronary angiography (one of five compared with zero of three, respectively). At multi-detector row CT, 76% (28 of 37) of all distal bypass touchdown segments were identified, but at coronary angiography, only 70% (26 of 37) were identified.
  
  
  CONCLUSIONS
  Multi-detector row CT provides extended information about coronary target site and therefore should be regarded as an ideal additive planning tool for complex minimally invasive procedures such as totally endoscopic coronary artery bypass grafting or minimally invasive direct coronary artery bypass grafting.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, J. W. Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. c.herzog@em.uni-frankfurt.de
authors.forename: Christopher
authors.initials: C
authors.lastname: Herzog
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Thomas
authors.initials: T
authors.lastname: Diebold
authors.forename: Mohamed Fahwad
authors.initials: MF
authors.lastname: Khan
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Stefan
authors.initials: S
authors.lastname: Schaller
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Flohr
authors.forename: Gerhardt
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D004724:Endoscopy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed