Willmann Jürgen K, Mayer Dieter, Banyai Martin, Desbiolles Lotus M, Verdun Francis R, Seifert Burkhardt, Marincek Borut, Weishaupt Dominik
Institute of Diagnostic Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Radiology. 2003 Nov;229(2):465-74. doi: 10.1148/radiol.2292021123.
To assess the technical feasibility of multi-detector row computed tomographic (CT) angiography in the assessment of peripheral arterial bypass grafts and to evaluate its accuracy and reliability in the detection of graft-related complications, including graft stenosis, aneurysmal changes, and arteriovenous fistulas.
Four-channel multi-detector row CT angiography was performed in 65 consecutive patients with 85 peripheral arterial bypass grafts. Each bypass graft was divided into three segments (proximal anastomosis, course of the graft body, and distal anastomosis), resulting in 255 segments. Two readers evaluated all CT angiograms with regard to image quality and the presence of bypass graft-related abnormalities, including graft stenosis, aneurysmal changes, and arteriovenous fistulas. The results were compared with McNemar test with Bonferroni correction. CT attenuation values were recorded at five different locations from the inflow artery to the outflow artery of the bypass graft. These findings were compared with the findings at duplex ultrasonography (US) in 65 patients and the findings at conventional digital subtraction angiography (DSA) in 27.
Image quality was rated as good or excellent in 250 (98%) and in 252 (99%) of 255 bypass segments, respectively. There was excellent agreement both between readers and between CT angiography and duplex US in the detection of graft stenosis, aneurysmal changes, and arteriovenous fistulas (kappa = 0.86-0.99). CT angiography and duplex US were compared with conventional DSA, and there was no statistically significant difference (P >.25) in sensitivity or specificity between CT angiography and duplex US for both readers for detection of hemodynamically significant bypass stenosis or occlusion, aneurysmal changes, or arteriovenous fistulas. Mean CT attenuation values ranged from 232 HU in the inflow artery to 281 HU in the outflow artery of the bypass graft.
Multi-detector row CT angiography may be an accurate and reliable technique after duplex US in the assessment of peripheral arterial bypass grafts and detection of graft-related complications, including stenosis, aneurysmal changes, and arteriovenous fistulas.
评估多排螺旋计算机断层扫描（CT）血管造影在评估外周动脉旁路移植术中的技术可行性，并评价其在检测移植相关并发症（包括移植血管狭窄、动脉瘤样改变和动静脉瘘）方面的准确性和可靠性。
对连续65例患者的85条外周动脉旁路移植血管进行四通道多排螺旋CT血管造影。每条旁路移植血管分为三段（近端吻合口、移植血管体行程和远端吻合口），共255段。两名阅片者对所有CT血管造影图像的质量以及旁路移植血管相关异常（包括移植血管狭窄、动脉瘤样改变和动静脉瘘）的存在情况进行评估。结果采用经Bonferroni校正的McNemar检验进行比较。在旁路移植血管从流入动脉到流出动脉的五个不同位置记录CT衰减值。将这些结果与65例患者的双功超声（US）检查结果以及27例患者的传统数字减影血管造影（DSA）检查结果进行比较。
在255个旁路血管段中，图像质量分别在250段（98%）和252段（99%）被评为良好或优秀。在检测移植血管狭窄、动脉瘤样改变和动静脉瘘方面，阅片者之间以及CT血管造影与双功超声之间均具有高度一致性（kappa = 0.86 - 0.99）。将CT血管造影和双功超声与传统DSA进行比较，在两名阅片者检测血流动力学显著的旁路血管狭窄或闭塞、动脉瘤样改变或动静脉瘘方面，CT血管造影和双功超声在敏感性或特异性上均无统计学显著差异（P > 0.25）。旁路移植血管流入动脉的平均CT衰减值为232 HU，流出动脉为281 HU。
在评估外周动脉旁路移植血管以及检测移植相关并发症（包括狭窄、动脉瘤样改变和动静脉瘘）方面，多排螺旋CT血管造影可能是双功超声之后一种准确可靠的技术。
