Sahiner Levent, Oto Ali, Aytemir Kudret, Hazirolan Tuncay, Karcaaltincaba Musturay, Akata Deniz
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Heart Surg Forum. 2012 Feb;15(1):E12-7. doi: 10.1532/HSF98.20111075.
The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).
Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.
Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.
Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.
本研究旨在探讨16层多层螺旋计算机断层扫描（MDCT）血管造影术在评估冠状动脉旁路移植术（CABG）患者移植物方面的诊断准确性。
纳入58例连续接受MDCT和传统有创冠状动脉造影的CABG患者。这两种检查之间的中位时间间隔为10天（范围1 - 32天）。计算MDCT检测闭塞移植物的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。还研究了MDCT血管造影检测通畅移植物中显著狭窄的准确性以及近端和远端吻合口的可评估性。
153个移植物中仅3个（2%）无法获得最佳诊断图像。对其余150个移植物的评估显示，MDCT血管造影术诊断闭塞移植物的敏感性、特异性、PPV、NPV和诊断准确性分别为87%、97%、94%、93%和92%。所有近端吻合口均能得到最佳显示。然而，在50个通畅的动脉移植物中有4个（8%）由于运动和手术夹伪影而无法评估远端吻合区域。MDCT血管造影检测显著狭窄病变的准确性相对较低（敏感性、特异性、PPV和NPV分别为67%、98%、50%和99%）。然而，显著病变的数量不足以得出可靠结论。
我们的研究表明，16层系统的MDCT血管造影术在评估冠状动脉旁路移植通畅性方面具有可接受的诊断性能。
