Non-invasive imaging of vein grafts with multislice computed tomography

Abstract

BACKGROUND: Multislice computed tomography (MSCT)-angiography is a new, emerging cardiovascular imaging modality. METHODS: This article reviews the "essentials" of venous bypass graft imaging by using MSCT, including the basic technical principles of MSCT, the radiological appearance of vein grafts and currently available literature. RESULTS: Multislice computed tomography (MSCT)-angiography allows an accurate evaluation of coronary bypass graft patency. Complete graft occlusion can be detected with a high diagnostic accuracy. However, detection and quantification of distal anastomosis stenosis is limited by MSCT when compared with invasive angiography due to limited spatial resolution and/or in the presence of metallic surgical clips. Vein graft disease can be diagnosed at early stages by imaging of non-calcified or calcifying plaques. CONCLUSIONS: Non-invasive multislice computed tomography (MSCT)-angiography can be used as "gatekeeper" in patients in whom invasive angiography is not the modality of first choice (e.g. atypical angina pectoris; inconclusive or equivocal or borderline positive ECG-stress test) or in patients who are at high risk for invasive catheter intervention in order to determine bypass graft patency. MSCT can be also applied for the evaluation of non-specific post-operative chest pain in patients after coronary bypass surgery, because extra-cardiac pathologies such as haematoma, abscess formation, pneumothorax, pulmonary embolism or sternal bone infections can be assessed simultaneously.