Yamamoto Masato, Kimura Fumiko, Niinami Hiroshi, Suda Yuji, Ueno Eiko, Takeuchi Yasuo
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Daini Hospital, Tokyo, Japan.
Ann Thorac Surg. 2006 Mar;81(3):820-7. doi: 10.1016/j.athoracsur.2005.08.069.
Sixteen-channel multidetector-row computed tomography (MDCT), with higher spatial and temporal resolution, enables noninvasive visualization of images with reduced motion artifact and breath-holding time. We compared images of 16-channel MDCT and selective bypass graft angiography among patients who had off-pump coronary artery bypass graft surgery.
The study, conducted from April 2003 to March 2004, involved 42 patients who underwent off-pump coronary artery bypass graft surgery. Samples yielded a total of 96 arterial grafts, 5 vein grafts. Sixteen-channel MDCT (LightSpeed Ultra 16; GE Healthcare, Milwaukee, Wisconsin) was performed on each patient using 500-ms or 600-ms rotation time, 0.625-mm slice thickness, and mean scanning time of approximately 24 seconds.
If several sequential anastomoses in one graft existed, each was calculated as a separate graft. Selective bypass graft angiography yielded a patency rate of 97% (155 of 160). Multidetector-row computed tomography enabled detection of 143 of 155 patent grafts and all 5 occluded grafts visualized by selective bypass graft angiography (100% sensitivity and 93% specificity for graft occlusion after exclusion of grafts not evaluated by MDCT). In 149 graft anastomoses of 143 patent grafts viewed by MDCT, 2 significant stenoses were detected by both selective bypass graft angiography and MDCT. Twelve distal anastomoses were not evaluated by MDCT because of metallic clip artifacts. Evaluation possible graft anastomoses were 92%. Sensitivity and specificity for significant stenosis after exclusion of graft anastomoses not evaluated by MDCT were 100% and 99%, respectively.
High-quality 16-channel MDCT images allowed detection of graft occlusion and significant stenosis of graft anastomosis after off-pump coronary artery bypass graft surgery, demonstrating an alternative tool less invasive than selective bypass graft angiography to assess grafts after surgery.
16层多排螺旋计算机断层扫描（MDCT）具有更高的空间和时间分辨率，能够在减少运动伪影和屏气时间的情况下对图像进行无创可视化。我们对非体外循环冠状动脉搭桥手术患者的16层MDCT图像和选择性搭桥血管造影图像进行了比较。
该研究于2003年4月至2004年3月进行，纳入了42例行非体外循环冠状动脉搭桥手术的患者。样本共获得96条动脉移植物和5条静脉移植物。对每位患者使用16层MDCT（LightSpeed Ultra 16；GE医疗保健公司，威斯康星州密尔沃基）进行扫描，旋转时间为500毫秒或600毫秒，层厚0.625毫米，平均扫描时间约为24秒。
如果一条移植物中有多个连续的吻合口，则每个吻合口都被视为一条单独的移植物。选择性搭桥血管造影显示通畅率为97%（160条中的155条）。多排螺旋计算机断层扫描能够检测出155条通畅移植物中的143条以及选择性搭桥血管造影显示的所有5条闭塞移植物（在排除未通过MDCT评估的移植物后，对移植物闭塞的敏感性为100%，特异性为93%）。在MDCT观察的143条通畅移植物的149个移植物吻合口中，选择性搭桥血管造影和MDCT均检测到2处明显狭窄。由于金属夹伪影，12个远端吻合口未通过MDCT评估。可评估的移植物吻合口比例为92%。在排除未通过MDCT评估的移植物吻合口后，对明显狭窄的敏感性和特异性分别为100%和99%。
高质量的16层MDCT图像能够检测非体外循环冠状动脉搭桥手术后的移植物闭塞和移植物吻合口明显狭窄，证明了其是一种比选择性搭桥血管造影侵入性更小的术后评估移植物的替代工具。
