Schlosser Thomas, Konorza Thomas, Hunold Peter, Kühl Hilmar, Schmermund Axel, Barkhausen Jörg
Department of Diagnostic and Interventional Radiology, University Hospital, Essen, Germany.
J Am Coll Cardiol. 2004 Sep 15;44(6):1224-9. doi: 10.1016/j.jacc.2003.09.075.
The aim of this study was to evaluate the diagnostic accuracy of a 16-detector row computed tomography (CT) scanner for the assessment of coronary artery bypass grafts.
A new generation of multislice spiral CT scanners, equipped with more and thinner detector rows, allows for reliable noninvasive detection of obstructive coronary artery disease.
The study included 51 consecutive patients. Three patients had to be excluded from the study due to arrhythmias or fast heart rates despite beta-blockade. A total of 48 patients with 131 coronary artery bypass grafts (internal mammary artery, n = 40; venous grafts, n = 91) were examined by computed tomography angiography (CTA) and by invasive coronary angiography (ICA) using a 16-detector row CT scanner. For cardiac protocols, only the 12 inner detector rings are applied. All CT examinations were performed with retrospective electrocardiogram gating at a mean heart rate of 64 +/- 5 beats/min; 120 ml of Xenetix 300 (Guerbert GmbH, Sulzbach, Germany) were continuously injected. The bypass graft patency and the presence of stenoses as well as the proximal and distal anastomoses were evaluated by two experienced readers.
All bypass grafts and 74% of the distal bypass anastomoses could be visualized by CTA; 21 bypass graft occlusions and 1 significant stenosis were detected by CTA and confirmed by ICA. Five false positive and one false negative finding resulted in a sensitivity of 96%, a specificity of 95%, a positive predictive value of 81%, and a negative predictive value of 99%.
Sixteen-detector row CT scanner technology allows for the reliable visualization of coronary bypass grafts. Dysfunctional bypass grafts can be detected with high diagnostic accuracy. This technology can be used as a noninvasive test for patients with suspected graft dysfunction.
本研究旨在评估16排螺旋计算机断层扫描（CT）扫描仪对冠状动脉旁路移植术的诊断准确性。
新一代多层螺旋CT扫描仪配备了更多、更薄的探测器排，能够可靠地无创检测阻塞性冠状动脉疾病。
本研究纳入51例连续患者。3例患者因心律失常或尽管使用了β受体阻滞剂但心率仍快而被排除在研究之外。使用16排CT扫描仪对48例患者的131条冠状动脉旁路移植血管（乳内动脉，n = 40；静脉移植血管，n = 91）进行了计算机断层扫描血管造影（CTA）和有创冠状动脉造影（ICA）检查。对于心脏扫描方案，仅使用12个内部探测器环。所有CT检查均采用回顾性心电图门控，平均心率为64±5次/分钟；持续注射120 ml的Xenetix 300（德国苏尔茨巴赫Guerbert GmbH公司）。由两名经验丰富的阅片者评估旁路移植血管的通畅情况、狭窄的存在情况以及近端和远端吻合口情况。
CTA能够显示所有旁路移植血管以及74%的远端旁路吻合口；CTA检测到21处旁路移植血管闭塞和1处明显狭窄，并经ICA证实。5例假阳性和1例假阴性结果导致敏感性为96%，特异性为9５%，阳性预测值为81%，阴性预测值为99%。
16排CT扫描仪技术能够可靠地显示冠状动脉旁路移植血管。功能异常的旁路移植血管能够以较高的诊断准确性被检测到。该技术可作为疑似移植血管功能异常患者的无创检查方法。
