To assess the efficacy of magnetic resonance (MR) imaging in evaluating graft patency after coronary bypass surgery, 20 patients who had prior surgery (average 5.5 years, range 1.5 to 14) and recent cardiac catheterization because of chest pain were studied. No patient had surgical intervention or change in symptoms in the time interval between catheterization and MR imaging. These 20 patients had a total of 47 grafts, defined as proximal anastomoses: 20 to the left anterior descending or diagonal artery (LAD), 13 to the left circumflex artery marginal branches (LCX), and 14 to the right coronary artery or posterior descending artery (RCA). The patients underwent cardiac and respiratory gated MR scans in a 0.5 tesla magnet with an echo time of 22 msec and two repetitions in a 128 x 256 matrix. In-plane resolution was 2.7 mm. Every patient had a scan in the transaxial plane and some underwent scanning in the sagittal and coronal planes as well. A graft was considered patent by MR when a signal-free lumen was visualized in an anatomic position consistent with that of a bypass graft, had a lumen larger than the native vessels, was seen on more than one slice, and was seen at a level higher than that of the native vessels. If a known graft was not seen it was considered occluded. The scans were interpreted by consensus of two physicians aware of the operative but not the cardiac catheterization data. Twenty-six of 29 patent grafts and 13 of 18 occluded grafts were correctly classified (sensitivity 90%, specificity 72%). Eighteen of 20 (90%) LAD grafts, 11 of 14 (79%) RCA grafts, and 11 of 13 (85%) LCX grafts were correctly classified. When the results from three patients with technically poor studies because of poor cardiac gating were excluded, the overall sensitivity and specificity were 92% and 85%, respectively. This study demonstrates the high sensitivity and moderate specificity of MR for evaluating the patency of coronary artery bypass grafts, particularly LAD grafts. Circulation 76, No. 4, 786-791, 1987. INCREASING NUMBERS of patients with previous coronary artery bypass surgery
In order to optimize overall cardiac image quality on MR images experienced observers were asked to rank and rate MR images of the heart. The effect of phase-encoding direction and use of cardiac triggering with and without respiratory gating was examined in three orthogonal imaging planes. Results indicate that use of both respiratory and cardiac gating yields the best images. Adequate images of the heart can be obtained without respiratory gating. The quality of images of the heart can be optimized by proper selection of the direction of the phase-encoding gradient. These are improved by using horizontal phase encoding in the sagittal plane and vertical phase encoding in transverse and coronal planes.
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