Jungmann Florian, Emrich Tilman, Mildenberger Peter, Emrich Anna Lena, Düber Christoph, Kreitner K F
Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
Department of Cardiothoracic and Vascular Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
Rofo. 2018 Mar;190(3):237-249. doi: 10.1055/s-0043-120528. Epub 2017 Nov 3.
Coronary artery bypass grafting (CABG) is still an important therapeutic approach in the treatment especially of advanced coronary artery disease. In this study, we elucidate the current role of multidetector computed tomography angiography (MD-CTA) in imaging patients after CABG surgery.
This study is based on recent reports in the literature (2007 - 2016) on imaging of CABG using 64-slice MD-CT scanners and beyond. We included 13 reports that compared ECG-gated MD-CTA with conventional invasive coronary angiography (ICA) as the reference standard for the assessment of graft patency and for the detection of > 50 % stenoses. These studies had to provide absolute values for true-positive, true-negative, false-positive and false-negative results or at least allow calculation of these numbers. In total, 1002 patients with 2521 bypass grafts were the basis for this review.
The sensitivity and specificity for the assessment of graft patency or the detection of > 50 % graft stenosis were 97.2 % and 97.5 %, respectively. The negative and positive predictive values were 93.6 % and 99 %, respectively. By using prospective ECG-gating and an increasing pitch factor, the radiation dose exposure declined to 2.4 mSv in the latest reports. ECG-gated MD-CTA provides a fast and reliable, noninvasive method for assessing patients after CABG. The most substantial benefit of the newest CT scanner generations is a remarkable reduction of radiation dose exposure while maintaining a still excellent diagnostic accuracy during recent years.
· MD-CTA using 64-slice MDCT scanners and beyond is a reliable, noninvasive method for evaluating CABGs.. · Technical advances such as prospective ECG-gating, iterative reconstruction algorithms and high-pitch scanning lead to a remarkable drop-down in radiation dose exposures as low as 2.4 mSv.. · Despite significant dose reductions, MD-CTA could maintain a high diagnostic accuracy in evaluating CABGs in recent years..
· Jungmann F, Emrich T, Mildenberger P et al. Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery Bypass Grafts - Update 2017. Fortschr Röntgenstr 2018; 190: 237 - 249.
冠状动脉旁路移植术（CABG）仍然是治疗尤其是晚期冠状动脉疾病的重要治疗方法。在本研究中，我们阐明了多排螺旋计算机断层血管造影（MD-CTA）在CABG术后患者成像中的当前作用。
本研究基于近期文献（2007 - 2016年）中关于使用64层及以上MD-CT扫描仪对CABG进行成像的报道。我们纳入了13篇将心电图门控MD-CTA与传统有创冠状动脉造影（ICA）进行比较的报告，后者作为评估移植血管通畅性和检测>50%狭窄的参考标准。这些研究必须提供真阳性、真阴性、假阳性和假阴性结果的绝对值，或者至少允许计算这些数值。总共1002例患者的2521条旁路移植血管是本综述的基础。
评估移植血管通畅性或检测>50%移植血管狭窄的敏感性和特异性分别为97.2%和97.5%。阴性和阳性预测值分别为93.6%和99%。通过使用前瞻性心电图门控和增加螺距因子，最新报告中的辐射剂量暴露降至2.4 mSv。心电图门控MD-CTA为评估CABG术后患者提供了一种快速、可靠的非侵入性方法。近年来，最新一代CT扫描仪的最大益处是在保持出色诊断准确性的同时，显著降低了辐射剂量暴露。
· 使用64层及以上MDCT扫描仪的MD-CTA是评估CABG的可靠非侵入性方法。· 前瞻性心电图门控、迭代重建算法和高螺距扫描等技术进步导致辐射剂量暴露显著降低，低至2.4 mSv。· 尽管剂量显著降低，但近年来MD-CTA在评估CABG时仍可保持较高的诊断准确性。
· Jungmann F, Emrich T, Mildenberger P等。冠状动脉旁路移植术的多排螺旋计算机断层血管造影（MD-CTA）——2017年更新。Fortschr Röntgenstr 2018; 190: 237 - 249。
