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(Circulation. 2006;114:2334-2341.)
© 2006 American Heart Association, Inc.

Imaging

Diagnostic Accuracy of Noninvasive Coronary Angiography in Patients After Bypass Surgery Using 64-Slice Spiral Computed Tomography With 330-ms Gantry Rotation

Dieter Ropers, MD; Falk-Karsten Pohle, MD; Axel Kuettner, MD; Tobias Pflederer, MD; Katharina Anders, MD; Werner G. Daniel, MD; Werner Bautz, MD; Ulrich Baum, MD; Stephan Achenbach, MD

From the Departments of Internal Medicine 2 (D.R., F.P., T.P., W.G.D., S.A.) and Diagnostic Radiology (A.K., K.A., W.B., U.B.), University of Erlangen, Erlangen, Germany.

Correspondence to Dr Stephan Achenbach, Medizinische Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. E-mail stephan.achenbach{at}rzmail.uni-erlangen.de

Received March 31, 2006; revision received September 22, 2006; accepted September 29, 2006.

Background— 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.

Methods and Results— 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 (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).

Conclusions— 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.

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