Evaluation of patients after coronary artery bypass surgery: CT angiographic assessment of grafts and coronary arteries.
OBJECTIVE
To evaluate the accuracy of electrocardiography (ECG)-gated multi-detector row computed tomography (CT) in enabling the detection of obstruction of both bypass grafts and coronary arteries in symptomatic patients who have undergone coronary artery bypass grafting.


METHODS
ECG-gated contrast material-enhanced multi-detector row CT angiography was performed in 24 patients after bypass surgery. Two independent blinded observers evaluated all graft and coronary segments (> or =2.0-mm diameter) for occlusion and stenosis (50%-99% luminal reduction). Conventional angiography was regarded as the standard of reference. Descriptive parameters were calculated, and the results for arterial grafts, venous grafts, and coronary arteries, as well as for high and low heart rates, were compared by using a two-sided Fisher exact test.


RESULTS
The following results were obtained by observers 1 and 2, respectively: Of the 60 venous graft segments, 60 (100%) and 57 (95.0%) were assessable, with an overall detection of all 17 occlusions (both observers) and three (50.0%) and five (83.3%) of six stenoses. Of 26 arterial graft segments, 19 (73.1%) and 15 (57.7%) were assessable. In the assessable segments, four of four (100%) and two of three (66.7%) stenoses and occlusions were detected, while one and two obstructions were located in nonassessable segments. Of 211 coronary segments, 146 (69.2%) and 140 (66.4%) were assessable, and detection of 50%-100% obstruction yielded a sensitivity of 89.9% (71 of 79) and 79.4% (54 of 68) and a specificity of 74.6% (50 of 67) and 72.2% (52 of 72) for each observer. Unlike the assessment of venous and arterial grafts, assessment of the coronary arteries with multi-detector row CT was significantly better in patients with low heart rates (P <.01).


CONCLUSIONS
Multi-detector row CT allows noninvasive angiographic evaluation of both coronary arteries and bypass grafts in patients who have undergone bypass surgery. Multi-detector row CT is more effective in examining venous grafts compared with arterial grafts and diffusely diseased coronary arteries.
Nieman
Koen
K
Department of Radiology and Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, Room D 220, Rotterdam 3015 GD, The Netherlands. koennieman@hotmail.com
Pattynama
Peter M T
PM
Rensing
Benno J
BJ
Van Geuns
Robert-Jan M
RJ
De Feyter
Pim J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*