(Circulation. 1996;93:660-666.)
© 1996 American Heart Association, Inc.
Articles |
Value of Magnetic Resonance Imaging in Assessing Patency and Function of Coronary Artery Bypass Grafts
An Angiographically Controlled Study
From the Departments of Cardiology and Radiology (T.D.), Free University Hospital Amsterdam, Institute for Cardiovascular Research, and Interuniversity Cardiovascular Institute, Amsterdam, the Netherlands.
Correspondence to M.A. Galjee, Department of Cardiology, Free University Hospital, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands.
Background Previous studies have demonstrated the high sensitivity and moderate specificity of standard magnetic resonance (MR) spin-echo (SE) and gradient-echo (GE) techniques in predicting the patency of coronary artery bypass grafts. These techniques, however, do not provide quantitative information. Therefore, the objectives of this study were first to investigate whether MR cine GE images, performed in addition to standard SE images, have additional value for the assessment of graft patency and second to assess the graft function by measuring the flow pattern and flow rate with MR phase velocity imaging.
Methods and Results Forty-seven patients with previous
histories of coronary artery bypass grafting underwent
angiography and MR SE and cine GE phase velocity imaging. SE and GE
images were evaluated by three independent observers blinded to the
angiographic results. The spatial mean velocity and volume flow were
measured and repeated for each image at consecutive 50-millisecond
intervals throughout the cardiac cycle. The 47 patients had 98 proximal
aortotomies, of which 60 were single and 38 sequential grafts.
Seventy-three grafts were patent; 25 were occluded. Eighty-four
grafts (86%) were eligible for comparison of the results of SE and GE
images. Assessment of patency was inconclusive on SE images in 7
grafts (5 occluded by angiography) and on GE images in 7 grafts (2
occluded). A comparison of the results of contrast angiography and SE
and GE MR imaging techniques showed that both techniques had a high
sensitivity (both 98%) and somewhat lower specificity (85% and 88%,
respectively) for graft patency. Combined analysis of the SE
and GE images did not improve the accuracy. The strength of the
interobserver agreement on GE images was good (
=0.66), whereas on
SE
images the agreement was moderate (=0.51). Adequate MR phase
velocity profiles were obtained in 62 (85%) of the 73 angiographically
patent grafts. Graft flow was characterized by a balanced biphasic
forward flow pattern. The volume flow of sequential grafts to 3 regions
(136±106 mL/min) was significantly higher than in single grafts
(63±41 mL/min, P<.01).
Conclusions Considering the good interobserver agreement and the 85% success rate of quantitative flow measurements, cine GE phase velocity mapping is a promising clinical tool in the noninvasive assessment of graft patency and function.
Key Words: bypass • coronary disease • grafting • magnetic resonance imaging
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