Song Wei, Jin Shu-xuan, Du Yong-ping, Liu Jian-ping, He Ben, Wang Bin-yao
Department of Cardiology, Renji Hospital, Shanghai Second Medical University, Shanghai 200127, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2005 Aug;33(8):704-7.
The aim of this study was to evaluate the value of sixteen-detector row computed tomography angiography (CTA) for the assessment of coronary artery bypass graft (CABG).
Sixty-two consecutive patients undergoing coronary artery bypass grafting were recruited. Among them, 6 patients were excluded from the study due to unfavorable control of heart rate. A total of 56 patients with 152 coronary artery bypass grafts (internal mammary artery, n = 48; saphenous venous grafts, n = 104) were examined by computed tomography angiography (CTA) with sixteen-detector row CT and by conventional invasive coronary angiography (CAG). All CT procedures were performed with retrospective electrocardiogram gating method. The patients' mean heart rate was 58 +/- 6 beats/minute. 120 ml of Visipaque 320 were continuously injected with the rate of 4.0 ml/sec during the procedure. The patency and the stenosis of coronary artery bypass grafts were evaluated by two experienced readers.
All the coronary artery bypass grafts were visualized by CTA, and all the proximal bypass anastomoses and 71% of the distal bypass anastomoses were also visualized by CTA. Furthermore, 29 occlusions and 13 significant stenoses of coronary artery bypass grafts were detected by CTA. The comparison of the results between CTA and CAG showed that among all the 42 occluded and stenosed coronary artery bypass grafts detected by CTA, 34 were confirmed by CAG; among all the 110 normal coronary artery bypass grafts detected by CTA, 108 were confirmed by CAG. There were 8 false positive and 2 false negative findings, resulting in a sensitivity of 94%, a specificity of 95%, a positive predictive value of 86%, and a negative predictive value of 99%.
Sixteen-detector row CTA technology may provide a reliable visualization and higher diagnostic accuracy of coronary artery bypass grafts lesions. This technique can be used as a noninvasive procedure for the diagnosis of suspected coronary artery bypass grafts dysfunction.
本研究旨在评估十六排螺旋计算机断层血管造影（CTA）在评估冠状动脉旁路移植术（CABG）中的价值。
连续招募62例行冠状动脉旁路移植术的患者。其中，6例因心率控制不佳被排除在研究之外。共有56例患者的152条冠状动脉旁路移植血管（乳内动脉，n = 48；大隐静脉移植血管，n = 104）接受了十六排螺旋CT计算机断层血管造影（CTA）检查及传统有创冠状动脉造影（CAG）检查。所有CT检查均采用回顾性心电图门控技术。患者平均心率为58±6次/分钟。检查过程中以4.0 ml/秒的速率持续注射120 ml碘克沙醇320。由两名经验丰富的阅片者评估冠状动脉旁路移植血管的通畅情况及狭窄情况。
CTA可显示所有冠状动脉旁路移植血管，且能显示所有近端旁路吻合口以及71%的远端旁路吻合口。此外，CTA检测到29处冠状动脉旁路移植血管闭塞及13处显著狭窄。CTA与CAG结果比较显示，在CTA检测出的42处闭塞及狭窄的冠状动脉旁路移植血管中，34处经CAG证实；在CTA检测出的110条正常冠状动脉旁路移植血管中，108条经CAG证实。有8例假阳性及2例假阴性结果，灵敏度为94%，特异度为95%，阳性预测值为86%，阴性预测值为99%。
十六排螺旋CTA技术可为冠状动脉旁路移植血管病变提供可靠的显影及较高的诊断准确性。该技术可作为诊断可疑冠状动脉旁路移植血管功能障碍时的一种无创检查方法。
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