Abstract
Purpose
Our aim was to evaluate the accuracy, sensitivity and specificity of 64-slice multidetector computed tomography (MDCT) in the assessment of occlusions and stenoses of arterial and venous bypass grafts and disease progression in the native vessels distal to the graft, and to compare the results with those of conventional coronary angiography.
Materials and methods
We enrolled 78 individuals (45 men, 33 women; mean age 59) and evaluated 213 bypass grafts using a 64-slice MDCT scanner. All patients underwent conventional coronary angiography with a mean time interval between the two examinations of 2 days.
Results
One patient was excluded due to arrhythmia during the examination. The 212 bypass grafts in the remaining 77 patients (98.7%) consisted of 115 (54%) venous grafts and 97 (46%) arterial grafts. In the 115 venous grafts, MDCT showed a sensitivity, specificity and accuracy of 100% in evaluating occluded grafts and a sensitivity of 94.4%, specificity of 98.4% and accuracy of 96.9% in evaluating significant stenoses. In evaluating occluded arterial grafts, sensitivity was 83.3%, specificity 100% and accuracy 98.9%, whereas in evaluating stenoses of arterial grafts, sensitivity was 100%, specificity 97.7% and accuracy 98%.
Conclusions
Sensitivity, specificity and accuracy in evaluating native coronary vessels distal to the graft allow for a complete assessment of the surgical and native circulation. The examination appears therefore to be exhaustive in ruling out or confirming the presence of diseased vessels in the postoperative follow-up.
Riassunto
Obiettivo
Scopo dello studio è valutare l’accuratezza diagnostica, la sensibilità e la specificità della tomografia computerizzata (TC) a 64 strati nella valutazione delle occlusioni e delle stenosi di bypass arteriosi e venosi e dell’eventuale progressione di malattia a carico dei vasi nativi distali all’anastomosi chirurgica, rapportando i risultati ottenuti con i reperti della coronarografia convenzionale (CC).
Materiali e metodi
Sono stati sottoposti a studio con TC 64 strati 78 pazienti (45 maschi, 33 femmine; età media 59 anni) per un totale di 213 bypass (115 innesti venosi e 98 arteriosi). Tutti i pazienti sono andati incontro a CC dopo una media di 2 giorni.
Risultati
Un paziente (1,3%) è stato escluso per l’insorgenza di un episodio aritmico durante l’esame. I 212 bypass presi in esame dei rimanenti 77 soggetti (98,7%), erano costituiti da 115 (54%) innesti venosi e 97 (46%) innesti arteriosi. Nei 115 by-pass venosi, la TC ha mostrato una sensibilità, una specificità ed una accuratezza diagnostica del 100% nella valutazione dei bypass occlusi e una sensibilità del 94,4%, una specificità del 98,4% ed un’accuratezza diagnostica del 96,9% nella valutazione delle stenosi significative. Nei bypass arteriosi occlusi, la sensibilità è stata dell’83,3%, la specificità del 100% e l’accuratezza diagnostica del 98,9%, mentre nelle stenosi dei bypass arteriosi, la sensibilità è stata del 100%, la specificità del 97,7% e l’accuratezza diagnostica del 98%.
Conclusioni
Come dimostrato dai risultati ottenuti, la correttezza delle informazioni fornite dalla TC si avvicina a quelle della CC consentendo una completa valutazione del circolo chirurgico e nativo e risultando completamente esaustivo nell’escludere o confermare la presenza di patologia vasale nel follow-up post-operatorio.
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Romagnoli, A., Patrei, A., Mancini, A. et al. Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries. Radiol med 115, 1167–1178 (2010). https://doi.org/10.1007/s11547-010-0580-6
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DOI: https://doi.org/10.1007/s11547-010-0580-6
Keywords
- Coronary artery bypass grafting
- Multislice computed tomography
- Noninvasive coronary angiography
- Coronary CT