Coronary Artery Bypass Grafts: Assessment with Multidetector CT in the Early and Late Postoperative Settings

http://radiographics.rsna.org/content/25/4/881.full
Aletta Ann Frazier, MD ; Fauzia Qureshi, MD ; Katrina M. Read, DDR ; Robert C. Gilkeson, MD ; Robert S. Poston, MD ; Charles S. White, MD

1 From the Departments of Diagnostic Imaging (A.A.F., F.Q., K.M.R., C.S.W.) and Cardiac Surgery (R.S.P.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC (A.A.F.); Philips Medical Systems, Cleveland, Ohio (K.M.R.); and the Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.C.G.). Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Annual Meeting. Received July 26, 2004; revision requested October 13 and received March 16, 2005; accepted March 17. K.M.R. is an employee of Philips Medical Systems; R.S.P. has received a grant for research on the aortic connector from St Jude Medical; C.S.W. receives grant funding from Philips Medical Systems; all other authors have no financial relationships to disclose.

Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease. It is well known that the long-term clinical outcome after myocardial revascularization depends on the patency of the bypass grafts. In the past, invasive coronary angiography was used to assess the status of the grafts and check for graft occlusion. Recently, computed tomography (CT), particularly multidetector CT with electrocardiographic gating, has emerged as an important diagnostic tool for evaluation of CABGs in both the early (≤1 month) and late (>1 month) postoperative settings. A variety of postoperative complications may manifest as dyspnea and chest pain, thereby mimicking recurrent angina secondary to graft occlusion. Owing to its improved spatial resolution compared with that of earlier-generation CT scanners and its ability to produce three-dimensional and multiplanar images, multidetector CT has assumed an integral role in characterization of graft patency while allowing investigation of alternative postoperative complications. In addition, the expanded capabilities of volumetric imaging may provide valuable information in preoperative planning for repeat CABG surgery.