title: Diagnostic performance of 16- and 64-section spiral CT for coronary artery bypass graft assessment: meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis to evaluate the accuracy of 16- and 64-section spiral computed tomography (CT) to help assess coronary artery bypass grafts (CABGs).
  
  
  METHODS
  The MEDLINE, Cochrane library, and BioMed Central databases were searched for relevant original articles published up to May 2007. Major criteria for article inclusion were that it (a) used multisection CT as a diagnostic test for the assessment of significant lesions (occlusion or >50% stenosis) of CABG, (b) used a 16- or 64-section scanner, and (c) used coronary angiography as the reference standard. After data extraction, the analysis was performed according to a random-effects model. Between-study statistical heterogeneity was also assessed by using the Cochran Q chi(2) test.
  
  
  RESULTS
  Of 158 screened articles, 15 fulfilled all inclusion criteria. Graft assessability (including distal anastomosis) ranged from 78%-100% among all included studies (mean, 92.4%; 90% with 16- and 96% with 64-section CT; P < .001). Statistical heterogeneity was observed for specificity and positive likelihood ratio (LR), justifying the use of the random-effects model. The analysis, pooled from 15 studies (723 patients, 2023 CABGs), provided the following results for the assessment of graft obstruction (occlusion and >50% stenosis): sensitivity, 97.6% (95% confidence interval [CI]: 96%, 98.6%); specificity, 96.7% (95% CI: 95.6%, 97.5%); positive predictive value, 92.7% (95% CI: 90.5%, 94.6%); negative predictive value, 98.9% (95% CI: 98.2%, 99.4%); positive LR, 23.42 (95% CI: 13.69, 40.07); negative LR, 0.045 (95% CI: 0.028, 0.071); and diagnostic odds ratio, 780.32 (95% CI: 379.12, 1606.1).
  
  
  CONCLUSIONS
  Multisection CT provided high accuracy for the evaluation of CABG obstruction in assessable conduits, and might be used as a noninvasive tool for the evaluation of suspected graft dysfunction in patients who are at high risk for complications from coronary angiography.
authors.affiliation: Departments of Radiology, University Hospital of Caen, Avenue Côte de Nacre 14033 Caen, Normandy, France. hamon-mi@chu-caen.fr
authors.forename: Michèle
authors.initials: M
authors.lastname: Hamon
authors.forename: Olivier
authors.initials: O
authors.lastname: Lepage
authors.forename: Patrizia
authors.initials: P
authors.lastname: Malagutti
authors.forename: John W
authors.initials: JW
authors.lastname: Riddell
authors.forename: Rémy
authors.initials: R
authors.lastname: Morello
authors.forename: Denis
authors.initials: D
authors.lastname: Agostini
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
mesh_terms: D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*