Published Online
on February 24, 2003

A more recent version of this article appeared on March 25, 2003

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Submitted on October 18, 2002
Revised on December 16, 2002
Accepted on December 17, 2002

Value of Magnetic Resonance Imaging for the Noninvasive Detection of Stenosis in Coronary Artery Bypass Grafts and Recipient Coronary Arteries

Susan E. Langerak PhD, Hubert W. Vliegen MD, J. Wouter Jukema MD, Patrik Kunz PhD, Aeilko H. Zwinderman PhD, Hildo J. Lamb PhD, Ernst E. van der Wall MD^*, and Albert de Roos MD

From the Departments of Cardiology (S.E.L., H.W.V., J.W.J., E.E.v.d.W.), Radiology (S.E.L., P.K., H.J.L., A.d.R.), and Medical Statistics (A.H.Z.), Leiden University Medical Center, Leiden, and Interuniversity Cardiology Institute of the Netherlands (S.E.L.), Utrecht, the Netherlands.

^* To whom correspondence should be addressed. E-mail: E.E.van_der_Wall{at}LUMC.nl.

Background--Magnetic resonance imaging (MRI) is a potential noninvasive diagnostic tool to detect coronary artery bypass graft stenosis, but its value in clinical practice remains to be established. We investigated the value of MRI in detecting stenotic grafts, including recipient vessels.

Methods and Results--We screened for inclusion 173 consecutive patients who were scheduled for coronary angiography because of recurrent chest pain after coronary artery bypass grafting (CABG). We studied 69 eligible patients with 166 grafts (81 single vein, 44 sequential vein, and 41 arterial grafts). MRI with baseline and stress flow mapping was performed. Both scans were successful in 80% of grafts. Grafts were divided into groups with stenosis 50% (n=72) and 70% (n=48) in the graft or recipient vessels. Marginal logistic regression was used to predict the probability for the presence of stenosis per graft type using multiple MRI variables. Receiver operator characteristics (ROC) analysis was performed to assess the diagnostic value of MRI. Sensitivity (95% confidence interval)/specificity (95% confidence interval) in detecting single vein grafts with stenosis 50% and 70% were 94% (86 to 100)/63% (48 to 79) and 96% (87 to 100)/92% (84 to 100), respectively.

Conclusions--MRI with flow mapping is useful for identifying grafts and recipient vessels with flow-limiting stenosis. Flow scans could be obtained in 80% of the grafts. This proof-of-concept study suggests that noninvasive MRI detection of stenotic grafts in patients who present with recurrent chest pain after CABG may be useful in selecting those in need of an invasive procedure.

Key words: magnetic resonance imaging • stenosis • bypass

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