Letter to the EditorNon-invasive, three-dimensional visualization of coronary artery bypass grafts by multislice spiral computed tomography
Introduction
X-ray coronary angiography is the reference standard for investigation of coronary artery bypass grafts (CABGs). In clinical practice, this method of imaging has several disadvantages. The procedure is invasive, with a small, nevertheless not negligible, procedure-related mortality and morbidity. The axial course and relative lack of movement of at least the proximal segments facilitate computer tomography (CT) imaging of CABGs. The latest generation of multislice spiral computed tomography (MSCT) scanners permits image acquisition in four parallel slices with a rotation time of 500 ms. Using the simultaneously recorded ECG, images can be reconstructed with a data acquisition window of ≤250 ms [1].
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Case report
We investigated the applicability and image quality of contrast-enhanced bypass grafts visualization using MSCT scanner of the latest generation and a new ECG-gated image reconstruction algorithm (Advantage Windows 4.0, GE Medical System, Milwaukee, USA, elaborated using the CARDIO IQ program) in a 70-year-old man with a remote history of multiple myocardial infarction and CABGs. In 1984, after the first episode of myocardial infarction, he received a triple safenous venous coronary graft
Discussion
Investigation of CABGs by MSCT needs to be validated in direct comparison to other invasive and noninvasive techniques. Despite reliable detection of bypass graft patency with high sensitivity and specificity, the clinically satisfactory detection of bypass graft stenosis by magnetic resonance angiography is not yet possible [2]. In previous studies, the use of spiral computed tomography improved the specificity and therefore the accuracy of bypass graft assessment compared with conventional
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Cited by (3)
Imaging of left main coronary artery dissection with multislice computed tomography
2007, International Journal of CardiologyCitation Excerpt :In large series of patients undergoing MSCT with commercially available 16-slice scanners, indeed, a significant percentage of coronary segments could not be assessed in terms of detection or exclusion of a significant coronary stenosis; moreover, luminal analysis had to be limited to coronary segments with diameter larger than 1,5 to 2 mm [3]. Nevertheless, several reports have outlined the current MSCT diagnostic possibilities in definite clinical subsets: MSCT angiography is helpful in detecting large coronary collaterals [4] or the course of abnormal coronary vessels [5]; it is useful to evaluate the need and to reduce the numbers of invasive angiography in selected patients with unclear chest pain [6] and can identify patency of coronary artery grafts [7,8]. In some cases MSCT findings are reliable enough to refer symptomatic patients to percutaneous interventions [9], even with accurate assessment of plaque texture despite heavy calcification [10].
Endocardial fibrosis in subacute non-Q wave myocardial infarction demonstrated by multislice computed tomography
2006, International Journal of Cardiology