title: Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation.
abstract: BACKGROUND
  Multidetector computed tomographic angiography (MDCT) has been shown to allow detection of coronary artery bypass graft (CABG) occlusions and stenoses. However, the assessment of native coronary arteries in addition to CABG has thus far not been sufficiently validated.
  
  
  RESULTS
  Fifty patients with a total of 138 CABG (34 mammary grafts, 3 radial grafts, 101 venous grafts) were investigated by MDCT (0.6-mm collimation, 32 detector rows, 2 focal points, 330-ms rotation) 9 to 252 months (mean, 106 months) after surgery. CABG and all native coronary arteries with a diameter of > 1.5 mm were evaluated for the presence of significant stenoses (> or = 50% diameter reduction). Results were compared with quantitative coronary angiography. By MDCT, all CABG were evaluable and were correctly classified as occluded (n=38) or patent (n=100). Sensitivity for stenosis detection in patent grafts was 100% (16/16) with a specificity of 94% (79/84). For the per-segment evaluation of native coronary arteries and distal runoff vessels, sensitivity in evaluable segments (91%) was 86% (87/101) with a specificity of 76% (354/465). If evaluation was restricted to nongrafted arteries and distal runoff vessels, sensitivity was 86% (38/44) with a specificity of 90% (302/334). On a per-patient basis, classifying patients with at least 1 detected stenosis in a CABG, a distal runoff vessel, or a nongrafted artery or with at least 1 unevaluable segment as "positive," MDCT yielded a sensitivity of 97% (35/36) and specificity of 86% (12/14).
  
  
  CONCLUSIONS
  We found that 64-slice MDCT permits the evaluation of bypass grafts and the assessment of the native coronary arteries for the presence of stenosis.
authors.affiliation: Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Ropers
authors.forename: Falk-Karsten
authors.initials: FK
authors.lastname: Pohle
authors.forename: Axel
authors.initials: A
authors.lastname: Kuettner
authors.forename: Tobias
authors.initials: T
authors.lastname: Pflederer
authors.forename: Katharina
authors.initials: K
authors.lastname: Anders
authors.forename: Werner G
authors.initials: WG
authors.lastname: Daniel
authors.forename: Werner
authors.initials: W
authors.lastname: Bautz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Baum
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*