Summary of applications, strengths and limitations of various imaging modalities.
| Imaging modality | Key applications | Strengths | Limitations | Evidence |
|---|---|---|---|---|
| Echocardiography (2D, Doppler, speckle-tracking) | Pre & postoperative LV function, GLS, diastolic recovery, intraoperative renal prognosis (RRI) | Widely available, noninvasive, sensitive for subclinical dysfunction (GLS) | Operator-dependent, limited use in obese/postoperative patients | Speckle-tracking superior to conventional LVEF for prognosis [5, 8, 13] |
| CTA | Preoperative vessel/conduit mapping, intraoperative planning, early graft failure detection, long-term patency assessment | High resolution, fast, reliable roadmap, less invasive than invasive angiography | Radiation exposure, iodinated contrast nephropathy, less accurate with heavy calcification | BYPASS-CTCA trial: reduced complications, better surgical planning [1, 6, 14] |
| DUS | Conduit mapping (saphenous/radial), intraoperative graft flow verification, postoperative surveillance (CABG & PAD) | Noninvasive, safe, real-time hemodynamic data | Operator-dependent, less accurate in calcified/distal vessels | Routine surveillance reduces graft failure, limb loss [10, 15] |
| MRA | Alternative to CTA in renal risk patients, PAD & CABG mapping, postoperative graft monitoring | No radiation, safe in CKD, high concordance with DSA | Lower spatial resolution, motion artifacts, contraindicated with implants | QISS and non-contrast MRA: > 85–90% accuracy vs. invasive angiography [7] |
| PET/SPECT | Myocardial perfusion, ischemia, viability, myocardial blood flow (PET) | Quantitative perfusion (PET), strong prognostic value, widely validated | Radiation exposure, lower spatial resolution (SPECT), cost (PET) | 2022 ASNC/AAPM/SCCT/SNMMI guideline for the use of CT in hybrid nuclear/CT cardiac imaging [16] |
GLS: global longitudinal strain; LV: left ventricular; RRI: renal resistive index; LVEF: left ventricular ejection fraction; CTA: computed tomography angiography; DUS: duplex ultrasound; CABG: coronary artery bypass graft; PAD: peripheral arterial disease; MRA: magnetic resonance angiography; CKD: chronic kidney disease; DSA: digital subtraction angiography; QISS: Quiescent-Inflow Single-Shot; PET: positron emission tomography; SPECT: single-photon emission computed tomography; 18F-FDG: 18Flourine-Fluorodeoxyglucose; MR: magnetic resonance.