Ropers Dieter, Pohle Falk-Karsten, Kuettner Axel, Pflederer Tobias, Anders Katharina, Daniel Werner G, Bautz Werner, Baum Ulrich, Achenbach Stephan
Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.
Circulation. 2006 Nov 28;114(22):2334-41; quiz 2334. doi: 10.1161/CIRCULATIONAHA.106.631051. Epub 2006 Nov 6.
Multidetector computed tomographic angiography (MDCT) has been shown to allow detection of coronary artery bypass graft (CABG) occlusions and stenoses. However, the assessment of native coronary arteries in addition to CABG has thus far not been sufficiently validated.
Fifty patients with a total of 138 CABG (34 mammary grafts, 3 radial grafts, 101 venous grafts) were investigated by MDCT (0.6-mm collimation, 32 detector rows, 2 focal points, 330-ms rotation) 9 to 252 months (mean, 106 months) after surgery. CABG and all native coronary arteries with a diameter of > 1.5 mm were evaluated for the presence of significant stenoses (> or = 50% diameter reduction). Results were compared with quantitative coronary angiography. By MDCT, all CABG were evaluable and were correctly classified as occluded (n=38) or patent (n=100). Sensitivity for stenosis detection in patent grafts was 100% (16/16) with a specificity of 94% (79/84). For the per-segment evaluation of native coronary arteries and distal runoff vessels, sensitivity in evaluable segments (91%) was 86% (87/101) with a specificity of 76% (354/465). If evaluation was restricted to nongrafted arteries and distal runoff vessels, sensitivity was 86% (38/44) with a specificity of 90% (302/334). On a per-patient basis, classifying patients with at least 1 detected stenosis in a CABG, a distal runoff vessel, or a nongrafted artery or with at least 1 unevaluable segment as "positive," MDCT yielded a sensitivity of 97% (35/36) and specificity of 86% (12/14).
We found that 64-slice MDCT permits the evaluation of bypass grafts and the assessment of the native coronary arteries for the presence of stenosis.
多排螺旋计算机断层血管造影（MDCT）已被证明能够检测冠状动脉旁路移植术（CABG）的闭塞和狭窄情况。然而，迄今为止，除了CABG外，对自身冠状动脉的评估尚未得到充分验证。
对50例患者共138处CABG（34处乳内动脉移植、3处桡动脉移植、101处静脉移植）在术后9至252个月（平均106个月）进行MDCT检查（准直0.6mm，32排探测器，2个焦点，旋转时间330毫秒）。对CABG以及所有直径大于1.5mm的自身冠状动脉进行显著狭窄（直径减少≥50%）情况的评估。将结果与定量冠状动脉造影进行比较。通过MDCT，所有CABG均可评估，并被正确分类为闭塞（n = 38）或通畅（n = 100）。通畅移植血管狭窄检测的敏感性为100%（16/16），特异性为94%（79/84）。对于自身冠状动脉节段和远端流出血管的逐节段评估，可评估节段的敏感性为91%，其中狭窄检测敏感性为86%（87/101），特异性为76%（354/465）。如果评估仅限于未移植动脉和远端流出血管，敏感性为86%（38/44），特异性为90%（302/334）。以患者为基础，将在CABG、远端流出血管或未移植动脉中至少检测到1处狭窄或至少有1个不可评估节段的患者分类为“阳性”，MDCT的敏感性为97%（35/36），特异性为86%（12/14）。
我们发现64排MDCT能够评估旁路移植血管，并能评估自身冠状动脉是否存在狭窄。
