Evaluation of coronary bypass graft occlusion and stenosis with 64-detector-row computed tomography angiography

Background: A noninvasive imaging modality is desirable for the evaluation of coronary bypass graft stenosis and occlusion. Purpose: To prospectively evaluate the effectiveness of 64-detector-row computed tomography (DCT) for the assessment of coronary bypass grafts. Material and Methods: Forty-two patients (35 male, seven female, mean age 66.3 years) with 103 bypass grafts (32 arterial, 71 venous) were examined with 64-DCT. The evaluations were done by two radiologists blinded to the results of quantitative coronary angiography (QCA), used as the reference standard. Results: All of the 26 occluded grafts, nine of the 10 stenosed grafts, and 66 of the 67 patent grafts were correctly diagnosed with 64-DCT angiography. The sensitivity, specificity, and positive and negative predictive values for 64-DCT in detecting graft stenosis were 90%, 99%, 90%, and 99%, respectively. For graft occlusion, all were 100%. No statistically significant difference was found between 64-DCT and QCA for the evaluation of bypass grafts. Intermodality and interobserver agreement were excellent. Conclusion: 64-DCT angiography is a reliable, noninvasive diagnostic method for the assessment of coronary bypass grafts. It can be considered as a useful tool for follow-up purposes and may function as a gatekeeper before invasive procedures.