doi: 10.1161/hc0302.102598
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2002;105:328.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Detection of Vein Graft Disease Using High-Resolution Magnetic Resonance Angiography
From the Departments of Cardiology (S.E.L., H.W.V., J.W.J., E.E.V.D.W.), Radiology (S.E.L., A.D.R., P.K., H.J.L.), and Medical Statistics (A.H.Z.), Leiden University Medical Center, Leiden, the Netherlands; and Interuniversity Cardiology Institute of the Netherlands (S.E.L.), Utrecht, the Netherlands.
Correspondence to Prof Dr E.E. van der Wall, MD, Leiden University Medical Center, Department of Cardiology (C5-P), Albinusdreef 2, 2300 RC Leiden, PO Box 9600 2333 ZA, the Netherlands. E-mail E.E.van_der_Wall{at}LUMC.nl
Background— The application of previous magnetic resonance (MR) angiography techniques has enabled noninvasive differentiation between patent and occluded coronary artery bypass grafts. However, the detection of graft stenosis remains difficult. The purpose of our study was to determine the accuracy of high-resolution navigator-gated 3-dimensional (3-D) MR angiography in detecting vein graft disease.
Methods and Results— MR angiography was performed in addition to coronary angiography with quantitative coronary analysis in 56 vein grafts from 38 patients (mean age 66.6±9.3 years), who presented with recurrent chest pain after bypass surgery. Eighteen grafts showed a luminal stenosis 
50%, 11 grafts a stenosis 70%, and 6 grafts were occluded. All MR angiograms were evaluated independently by 2 blinded observers, who scored the presence of graft occlusion and graft stenosis 50% and 70% with a confidence level of 1 to 10. MR image quality was judged as insufficient in 6 grafts and these were excluded. Receiver-operator characteristic analysis revealed an area under the curve of 0.89 and 0.89 for identifying graft occlusion, 0.81 and 0.87 for stenosis 50%, and 0.82 and 0.79 for stenosis 70% for the 2 observers, respectively. Interobserver agreement in assessing graft occlusion and stenosis 50% and 70% was 94% (
=0.74, r=0.81), 72% (=0.40, r=0.66), and 82% (=0.53, r=0.72), respectively.
Conclusions— High-resolution navigator-gated 3-D MR angiography allows not only good differentiation between patent and occluded vein grafts but also the assessment of vein graft disease with a fair diagnostic accuracy. This approach offers perspective as a noninvasive diagnostic tool for patients who present with recurrent chest pain after vein graft surgery.
Key Words: magnetic resonance imaging • stenosis • bypass • angiography
This article has been cited by other articles:
 |
|
 |
|
  N I Stauder, B Klumpp, H Stauder, G Blumenstock, M Fenchel, A Kuttner, C D Claussen, and S Miller Assessment of coronary artery bypass grafts by magnetic resonance imaging Br. J. Radiol., December 1, 2007; 80(960): 975 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Malagutti, K. Nieman, W. B. Meijboom, C. A.G. van Mieghem, F. Pugliese, F. Cademartiri, N. R. Mollet, E. Boersma, P. P. de Jaegere, and P. J. de Feyter Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries Eur. Heart J., August 1, 2007; 28(15): 1879 - 1885. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Wittlinger, O. Dzemali, I. Martinovic, and A. Moritz Assessment of coronary artery bypass grafts patency with different magnetic resonance technologies. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 436 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, Z. A. Fayad, P. R. Moreno, M. Poon, R. Corti, and J. J. Badimon Atherothrombosis and High-Risk Plaque: Part II: Approaches by Noninvasive Computed Tomographic/Magnetic Resonance Imaging J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1209 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Karski, G. Djaiani, J. Carroll, M. Iwanochko, P. Seneviratne, P. Liu, W. Kucharczyk, L. Fedorko, T. David, and D. Cheng Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: A prospective randomized controlled clinical trial J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 309 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N I Stauder, A M Scheule, U Hahn, M Fenchel, F S Eckstein, U Kramer, C D Claussen, and S Miller Perioperative monitoring of flow and patency in native and grafted internal mammary arteries using a combined MR protocol Br. J. Radiol., April 1, 2005; 78(928): 292 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. I. Stauder, M. Fenchel, H. Stauder, A. Kuttner, A. M. Scheule, U. Kramer, C. D. Claussen, and S. Miller Assessment of minimally invasive direct coronary artery bypass grafting of the left internal thoracic artery by means of magnetic resonance imaging J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 607 - 614. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Marano, M. L. Storto, N. Maddestra, and L. Bonomo Could multidetector computed tomography play a role in the management of patients readmitted with recurrent chest pain after surgical coronary revascularization? J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 686 - 687. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report Eur. Heart J., November 1, 2004; 25(21): 1940 - 1965. [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Willmann, D. Weishaupt, R. Kobza, F. R. Verdun, B. Seifert, B. Marincek, and T. Boehm Coronary Artery Bypass Grafts: ECG-gated Multi-Detector Row CT Angiography--Influence of Image Reconstruction Interval on Graft Visibility Radiology, August 1, 2004; 232(2): 568 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Dewey, A. Lembcke, C. Enzweiler, B. Hamm, and P. Rogalla Isotropic half-millimeter angiography of coronary artery bypass grafts with 16-slice computed tomography Ann. Thorac. Surg., March 1, 2004; 77(3): 800 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Langerak, H. W. Vliegen, J. W. Jukema, P. Kunz, A. H. Zwinderman, H. J. Lamb, E. E. van der Wall, and A. de Roos Value of Magnetic Resonance Imaging for the Noninvasive Detection of Stenosis in Coronary Artery Bypass Grafts and Recipient Coronary Arteries Circulation, March 25, 2003; 107(11): 1502 - 1508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. L. F. Bedaux, M. B. M. Hofman, S. L. A. Vyt, J. G. F. Bronzwaer, C. A. Visser, and A. C. van Rossum Assessment of coronary artery bypass graft disease using cardiovascular magnetic resonance determination of flow reserve J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1848 - 1855. [Abstract] [Full Text] [PDF]
|
|