Assessment of Coronary Artery Bypass Graft Patency Using Multidetector Computed Tomography Application of Coronary MDCT Angiography for the Evaluation of Coronary Artery Disease

Sang Il Choi

doi:10.5124/jkma.2007.50.2.120

J Korean Med Assoc > Volume 50(2); 2007 > Article

Choi: Application of Coronary MDCT Angiography for the Evaluation of Coronary Artery Disease

Focused Issue

J Korean Med Assoc 2007; 50(2): 120-126.

Published online: January 20, 2007

DOI: http://dx.doi.org/10.5124/jkma.2007.50.2.120

Application of Coronary MDCT Angiography for the Evaluation of Coronary Artery Disease

Sang Il Choi, MD

Department of Diagnostic Radiology, Seoul National University College of Medicine E-mail: drsic@radiol.snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Despite several limitations, multidetector CT (MDCT) such as 64-slice scanner recently draws attention as the first-line test for the evaluation of chest pain or as a complementary test in patients with equivocal stress test results due to its high negative predictive value and high sensitivity and specificity. In addition, MDCT has the potential as a screening test in asymptomatic patients with a high risk of coronary artery disease. However, the evaluation of in-stent restenosis by MDCT is not infrequently challenging by artifacts caused by metal, especially in smaller stents. In this review, the author will discuss the role of MDCT in patients with suspected coronary artery disease and highlight cardiac MDCT as an emerging diagnostic tool in a routine clinical practice.

Figure 1.

A 52-year-old man with atypical chest pain, but normal treadmill test. (A) Cardiac MDCT shows tight discrete stenosis (90%) at proximal LAD and os area of 1st diagonal branch (arrow). (B) Conventional coronary angiography reveals tight stenosis at the same area (arrow) and is very well correlated with cardiac MDCT

Table 1.

Current application of Cardiac MDCT in a clinical context(Reference from 26).

Indications	Class^∗	Level of Evidence^∗
Assessment of Obstructive Disease in Symptomatic Patients	IIa	B
Work - up of known or suspected coronary anomalies	IIa	C
Follow - up after bypass surgery	IIb	C
Follow - up of percutaneous coronary intervention	III	C
Asymptomatic Persons as Screening Test for Atherosclerosis	III	C
Assessment of non - calcified plaque	III	C

∗ AHA evidence - based scoring system

Table 2.

Appropriate indication of Cardiac MDCT for the evaluation of coronary artery in a clinical context(Reference from 26).

Indications^∗	Median Score^∗
Detection of CAD: Symptomatic - Evaluation of Chest Pain Syndrome - Intermediate pre-test probability of CAD - ECG uninterpretable OR unable to exercise	7
Detection of CAD With Prior Test Results - Evaluation of Chest Pain Syndrome - Uninterpretable or equivocal stress test (exercise, perfusion, or stress echo)	8
Detection of CAD: Symptomatic - Acute Chest Pain - Intermediate pre-test probability of CAD - no ECG changes and serial enzymes negative	7
Detection of CAD: Symptomatic - Evaluation of Intra-Cardiac Structures - Evaluation of suspected coronary anomalies	9
Structure and Function - Morphology - Evaluation of coronary arteries in patients with new onset heart failure to assess etiology	7

∗ Appropriate Indications (Median Score 7-9)

Table 3.

Uncertain Indication of Cardiac MDCT for the evaluation of coronary artery in a clinical context(Reference from 26).

Indications^∗	Median Score^∗
Detection of CAD: Symptomatic - Evaluation of Chest Pain Syndrome - Intermediate pre-test probability of CAD - ECG interpretable AND able to exercise	5
Detection of CAD: Symptomatic - Acute Chest Pain - Low pre-test probability of CAD - no ECG changes and serial enzymes negative	5
Detection of CAD: Symptomatic - Acute Chest Pain - High pre-test probability of CAD - no ECG changes and serial enzymes negative	6
Detection of CAD: Symptomatic - Acute Chest Pain - “Triple rule out”-exclude obstructive CAD, aortic dissection, and pulmonary embolism - Intermediate pre-test probability for one of the above - ECG/no ST-segment elevation and initial enzymes negative	4
Detection of CAD: Asymptomatic (Without Chest Pain Syndrome) - High CHD risk (Framingham)	4
Risk Assessment: Preoperative Evaluation for Non - Cardiac Surgery - Intermediate perioperative risk	5
Detection of CAD: Post PCI - Evaluation of Chest Pain Syndrome - History of percutaneous revascularization with stents	5
Detection of CAD: Post CABG - Evaluation of Chest Pain Syndrome - Evaluation of bypass grafts and coronary anatomy	6
Structure and Function - Evaluation of Ventricular and Valvular Function - Evaluation of LV function following myocardial infarction OR in heart failure patients - Patients with technically limited images from echocardiogram	4

∗ Uncertain Indications (Median Score 4-6)

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