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Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction. Int J Cardiovasc Imaging 2015; 31 Suppl 2:223-32. [DOI: 10.1007/s10554-015-0751-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 01/12/2023]
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Lee E, Goo HW, Lee JY. Age- and gender-specific estimates of cumulative CT dose over 5 years using real radiation dose tracking data in children. Pediatr Radiol 2015; 45:1282-92. [PMID: 25801905 DOI: 10.1007/s00247-015-3331-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/23/2015] [Accepted: 02/24/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is necessary to develop a mechanism to estimate and analyze cumulative radiation risks from multiple CT exams in various clinical scenarios in children. OBJECTIVE To identify major contributors to high cumulative CT dose estimates using actual dose-length product values collected for 5 years in children. MATERIALS AND METHODS Between August 2006 and July 2011 we reviewed 26,937 CT exams in 13,803 children. Among them, we included 931 children (median age 3.5 years, age range 0 days-15 years; M:F = 533:398) who had 5,339 CT exams. Each child underwent at least three CT scans and had accessible radiation dose reports. Dose-length product values were automatically extracted from DICOM files and we used recently updated conversion factors for age, gender, anatomical region and tube voltage to estimate CT radiation dose. We tracked the calculated CT dose estimates to obtain a 5-year cumulative value for each child. The study population was divided into three groups according to the cumulative CT dose estimates: high, ≥30 mSv; moderate, 10-30 mSv; and low, <10 mSv. We reviewed clinical data and CT protocols to identify major contributors to high and moderate cumulative CT dose estimates. RESULTS Median cumulative CT dose estimate was 5.4 mSv (range 0.5-71.1 mSv), and median number of CT scans was 4 (range 3-36). High cumulative CT dose estimates were most common in children with malignant tumors (57.9%, 11/19). High frequency of CT scans was attributed to high cumulative CT dose estimates in children with ventriculoperitoneal shunt (35 in 1 child) and malignant tumors (range 18-49). Moreover, high-dose CT protocols, such as multiphase abdomen CT (median 4.7 mSv) contributed to high cumulative CT dose estimates even in children with a low number of CT scans. CONCLUSION Disease group, number of CT scans, and high-dose CT protocols are major contributors to higher cumulative CT dose estimates in children.
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Affiliation(s)
- Eunsol Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Abstract
Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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CT Angiography of Neonates and Infants: Comparison of Radiation Dose and Image Quality of Target Mode Prospectively ECG-Gated 320-MDCT and Ungated Helical 64-MDCT. AJR Am J Roentgenol 2015; 204:W184-91. [DOI: 10.2214/ajr.14.12846] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Assessment of Extracardiac and Intracardiac Anatomy by MD-CT. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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56
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Nie P, Yang G, Wang X, Duan Y, Xu W, Li H, Cao T, Liu X, Ji X, Cheng Z, Wang A. Application of prospective ECG-gated high-pitch 128-slice dual-source CT angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children. PLoS One 2014; 9:e115793. [PMID: 25546178 PMCID: PMC4278836 DOI: 10.1371/journal.pone.0115793] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the value of prospective ECG-gated high-pitch 128-slice dual-source CT (DSCT) angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children in comparison with transthoracic echocardiography (TTE). METHODS Eighty consecutive infants or children clinically diagnosed of congenital heart disease and suspected with extracardiac vascular anomaly were enrolled, and 75 patients were finally included in this prospective study. All patients underwent prospective ECG-gated high-pitch DSCT angiography after TTE with an interval of 1-7 days. The diagnostic accuracy and sensitivity of high-pitch DSCT angiography and TTE were compared according to the surgical/CCA findings. The image quality of DSCT was assessed using a five-point scale. The effective radiation dose (ED) was calculated. RESULTS A total of 17 congenital heart diseases and 162 separate extracardiac vascular anomalies were confirmed by surgical/CCA findings in 75 patients. The diagnostic accuracy of high-pitch DSCT angiography and TTE was 99.67% and 97.89%, respectively. The sensitivity of high-pitch DSCT angiography and TTE was 97.53% and 79.62%, respectively. There was significant difference regarding to the diagnostic accuracy and the sensitivity between high-pitch DSCT angiography and TTE (χ2 = 23.561 and 28.013, P<0.05). The agreement on the image quality scoring of DSCT between the two observers was excellent (κ = 0.81), and the mean score of image quality was 4.1±0.7. The mean ED of DSCT was 0.29±0.08 mSv. CONCLUSIONS Prospective ECG-gated high-pitch 128-slice DSCT angiography with low radiation dose and high diagnostic accuracy has higher sensitivity compared to TTE in the detection of congenital extracardiac vascular anomalies in infants and children.
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Affiliation(s)
- Pei Nie
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangjie Yang
- Department of Nuclear Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ximing Wang
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
- * E-mail:
| | - Yanhua Duan
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Wenjian Xu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haiou Li
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Ting Cao
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Xuejun Liu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaopeng Ji
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Zhaoping Cheng
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Anbiao Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Jinan, Shandong, China
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Thomas KE, Mann EH, Padfield N, Greco L, BenDavid G, Alzahrani A. Dual bolus intravenous contrast injection technique for multiregion paediatric body CT. Eur Radiol 2014; 25:1014-22. [DOI: 10.1007/s00330-014-3501-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/15/2014] [Accepted: 11/12/2014] [Indexed: 01/22/2023]
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Goo HW, Park JJ, Kim EAR, Won HS. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT. Pediatr Radiol 2014; 44:1169-74. [PMID: 24687619 DOI: 10.1007/s00247-014-2931-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/18/2014] [Accepted: 02/12/2014] [Indexed: 11/28/2022]
Abstract
Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea,
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Goo HW, Park SH, Koo HJ, Cho YH, Lee E. Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT. Pediatr Radiol 2014; 44:942-7. [PMID: 24535116 DOI: 10.1007/s00247-014-2900-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/22/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Imaging findings of bilateral pulmonary vein atresia have not been described. OBJECTIVE To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. MATERIALS AND METHODS Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. RESULTS All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. CONCLUSION Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea,
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Brambilla M, De Mauri A, Lizio D, Leva L, Carriero A, Carpeggiani C, Picano E. Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review. Phys Med 2014; 30:403-12. [DOI: 10.1016/j.ejmp.2013.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022] Open
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Impact of sinogram affirmed iterative reconstruction (SAFIRE) algorithm on image quality with 70 kVp-tube-voltage dual-source CT angiography in children with congenital heart disease. PLoS One 2014; 9:e91123. [PMID: 24614683 PMCID: PMC3948727 DOI: 10.1371/journal.pone.0091123] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 02/07/2014] [Indexed: 12/01/2022] Open
Abstract
Purpose To compare the image quality and diagnostic accuracy between sinogram affirmed iterative reconstruction (SAFIRE) algorithm and filtered back projection (FBP) reconstruction algorithm at 70 kVp-tube-voltage DSCT angiography in children with congenital heart disease (CHD). Materials and Methods Twenty-eight patients (mean age: 13 months; range: 2–48 months; male: 16; female: 12; mean weight: 8 kg) with CHD underwent 70 kVp DSCT angiography. Imaging data were reconstructed with both FBP and SAFIRE algorithms. Subjective image quality was evaluated on a five-point scale. The parameters of image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) on the objective image quality were compared for the two reconstruction algorithms. Surgery was performed in 20 patients, whereas conventional cardiac angiography (CCA) was performed in 8 patients. The diagnostic accuracy was evaluated on the surgical and/or CCA findings. The effective radiation doses were calculated. Results Compared to FBP algorithm, SAFIRE algorithm had significantly higher scores for subjective image quality (P<0.05), and lower image noise (P<0.05) as well as higher SNR &CNR values (P<0.05). There was no significant difference in the diagnostic accuracy between the FBP and SAFIRE algorithm (χ2 = 1.793, P>0.05). The mean effective dose for 70 kVp DSCT angiography was 0.30±0.13 mSv. Conclusions The SAFIRE algorithm can significantly reduce image noise and improve the image quality at 70 kVp DSCT angiography for the assessment of CHD in children.
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Abstract
Cardiac CT is increasingly utilized in children thanks to advanced scan techniques reducing cardiac and respiratory motion artifacts. Consequently, clinical indications of cardiac CT are not confined to the extracardiac evaluation and extended further to the assessment of intracardiac structures, coronary arteries, ventricular volumetry, and ventricular function. In addition, dual-energy CT allows the assessment of regional lung perfusion and ventilation. Four-dimensional airway evaluation is also useful and may be added to cardiac CT protocols. At the same time, a favorable risk-benefit ratio of cardiac CT can be achieved by means of various dose-saving techniques. Therefore, flexible scan techniques with minimal motion artifacts, low dose techniques without compromising excellent image quality, and extended clinical applications towards truly cardiac assessments constitute current trends in cardiac CT in children.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of
Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
South Korea
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63
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Free-breathing cine CT for the diagnosis of tracheomalacia in young children. Pediatr Radiol 2013; 43:922-8. [PMID: 23417231 DOI: 10.1007/s00247-013-2637-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/07/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tracheomalacia is characterized by excessive expiratory collapse of the trachea. OBJECTIVE To investigate the accuracy of free-breathing cine CT for diagnosis of tracheomalacia in young children with bronchoscopy as reference standard. MATERIALS AND METHODS In a retrospective study (May 2001-July 2008), a patient group (n = 27) of children with bronchoscopic evidence of tracheomalacia, and a control group (n = 320) underwent free-breathing cine CT. The tracheal shape on free-breathing cine CT was classified as round, lunate, elongated or crescentic. Cross-sectional area change of the trachea and age were compared between the groups and the diagnostic performance of free-breathing cine CT for tracheomalacia was evaluated. RESULTS The patient group showed significantly greater cross-sectional area change of the trachea (57.2% ± 22.2% vs. 10.6% ± 11.2%, P < 0.001) than the control group. If a cross-sectional area change of the trachea of 31.6% was used as a cut-off value for the diagnosis of tracheomalacia, the sensitivity, specificity and accuracy of cine CT were 96.3% (26/27), 97.2% (311/320) and 97.1% (337/347), respectively. If a crescentic shape during the expiratory phase was used, the sensitivity, specificity and accuracy were 51.9% (14/27), 98.8% (316/320) and 95.1% (330/347), respectively. CONCLUSION Free-breathing cine CT has potential to provide the diagnosis of tracheomalacia in young children.
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Lee SH, Jung JM, Song MS, Choi SJ, Chung WY. Evaluation of cardiovascular anomalies in patients with asymptomatic turner syndrome using multidetector computed tomography. J Korean Med Sci 2013; 28:1169-73. [PMID: 23960443 PMCID: PMC3744704 DOI: 10.3346/jkms.2013.28.8.1169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 05/23/2013] [Indexed: 11/20/2022] Open
Abstract
Turner syndrome is well known to be associated with significant cardiovascular abnormalities. This paper studied the incidence of cardiovascular abnormalities in asymptomatic adolescent patients with Turner syndrome using multidetector computed tomography (MDCT) instead of echocardiography. Twenty subjects diagnosed with Turner syndrome who had no cardiac symptoms were included. Blood pressure and electrocardiography (ECG) was checked. Cardiovascular abnormalities were checked by MDCT. According to the ECG results, 11 had a prolonged QTc interval, 5 had a posterior fascicular block, 3 had a ventricular conduction disorder. MDCT revealed vascular abnormalities in 13 patients (65%). Three patients had an aberrant right subclavian artery, 2 had dilatation of left subclavian artery, and others had an aortic root dilatation, aortic diverticulum, and abnormal left vertebral artery. As for venous abnormalities, 3 patients had partial anomalous pulmonary venous return and 2 had a persistent left superior vena cava. This study found cardiovascular abnormalities in 65% of asymptomatic Turner syndrome patients using MDCT. Even though, there are no cardiac symptoms in Turner syndrome patients, a complete evaluation of the heart with echocardiography or MDCT at transition period to adults must be performed.
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Affiliation(s)
- Sun Hee Lee
- Department of Pediatrics, Sungae Hospital, Seoul, Korea
| | - Ji Mi Jung
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Min Seob Song
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seok jin Choi
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Zacharias C, Alessio AM, Otto RK, Iyer RS, Philips GS, Swanson JO, Thapa MM. Pediatric CT: strategies to lower radiation dose. AJR Am J Roentgenol 2013; 200:950-6. [PMID: 23617474 PMCID: PMC4748846 DOI: 10.2214/ajr.12.9026] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The introduction of MDCT has increased the utilization of CT in pediatric radiology along with concerns for radiation sequelae. This article reviews general principles of lowering radiation dose, the basic physics that impact radiation dose, and specific CT integrated dose-reduction tools focused on the pediatric population. CONCLUSION The goal of this article is to provide a comprehensive review of the recent literature regarding CT dose reduction methods, their limitations, and an outlook on future developments with a focus on the pediatric population. The discussion will initially focus on general considerations that lead to radiation dose reduction, followed by specific technical features that influence the radiation dose.
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IYENGAR S, ROOBOTTOM CA. Cardiac multidetector CT: method, indications and applications. IMAGING 2013. [DOI: 10.1259/imaging.20100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Advanced functional thoracic imaging in children: from basic concepts to clinical applications. Pediatr Radiol 2013; 43:262-8. [PMID: 23417252 DOI: 10.1007/s00247-012-2466-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
Abstract
The lungs and airways are organs involved in fairly complex body functions, including ventilation, perfusion, respiratory motion and gas exchange. Imaging evaluation of the pediatric thorax is challenging because involuntary, nonsynchronous respiratory motions and cardiac pulsations degrade image quality appreciably. The extraction of clinically useful functional information from noninvasive imaging methods has been realized even in children thanks to recent technical advancements in thoracic imaging modalities. In this article, advanced functional thoracic imaging techniques in children, focusing on CT and MRI, will be explored from basic concepts to clinical applications.
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69
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Quantitative thoracic CT techniques in adults: can they be applied in the pediatric population? Pediatr Radiol 2013; 43:308-14. [PMID: 23417256 DOI: 10.1007/s00247-012-2467-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
Abstract
With the rapid evolution of the multidetector row CT technique, quantitative CT has started to be used in clinical studies for revealing a heterogeneous entity of airflow limitation in chronic obstructive pulmonary disease that is caused by a combination of lung parenchymal destruction and remodeling of the small airways in adults. There is growing evidence of a good correlation between quantitative CT findings and pathological findings, pulmonary function test results and other clinical parameters. This article provides an overview of current quantitative thoracic CT techniques used in adults, and how to translate these CT techniques to the pediatric population.
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Kim JW, Goo HW. Coronary artery abnormalities in Kawasaki disease: comparison between CT and MR coronary angiography. Acta Radiol 2013; 54:156-63. [PMID: 23482350 DOI: 10.1258/ar.2012.120484] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although CT coronary angiography (CTCA) and MR coronary angiography (MRCA) are increasingly used in patients with Kawasaki disease, comparison of coronary artery assessibility and diagnostic performance between the two imaging modalities has been rarely performed. PURPOSE To investigate which imaging modality, CTCA or MRCA, is better for evaluating coronary artery abnormalities in patients with Kawasaki disease. MATERIAL AND METHODS Between 2003 and 2011, 56 patients (38 boys/men; age range, 1-24 years) with Kawasaki disease underwent CTCA or MRCA (group A). Of these, 17 underwent both CTCA and MRCA (group B). Visibility of 11 coronary arterial segments in each patient was graded on a four-point scale. Coronary artery aneurysm, stenosis, and occlusion were evaluated by CTCA and MRCA, based on a reference standard obtained from cardiac catheterization, echocardiography, follow-up CTCA and MRCA, and clinical history. Coronary artery assessibility and diagnostic performance were compared between CTCA and MRCA. RESULTS In per-segment analysis, more segments were assessable on CTCA than on MRCA in both groups. In per-patient analysis of group B, no significant difference in the assessibility was found between CTCA (95.0%, 128.3/135 segments) and MRCA (92.4%, 124.8/135 segments) (P > 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTCA vs. MRCA were 93.1% vs. 77.9% (P < 0.001), 99.2% vs. 99.7% (P = 0.65), 96.8% vs. 98.7% (P = 0.65), 98.2% vs. 94.1% (P < 0.001), and 98.0% vs. 94.9% (P = 0.008), respectively, in group A, and 91.8% vs. 70.4% (P < 0.001), 99.5% vs. 99.5% (P = 1.000), 98.5% vs. 98.0% (P = 1.000), 97.2% vs. 91.1% (P = 0.006), and 97.6% vs. 92.3% (P = 0.004), respectively, in group B. CONCLUSION Although CTCA and MRCA show comparable assessibility in per-patient analysis, CTCA shows higher diagnostic performance than MRCA for evaluating coronary artery abnormalities in patients with Kawasaki disease.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Cardiac CT and MRI for congenital heart disease in Asian countries: recent trends in publication based on a scientific database. Int J Cardiovasc Imaging 2013; 29 Suppl 1:1-5. [PMID: 23344910 DOI: 10.1007/s10554-013-0184-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Abstract
In the past 12 years, during the process of imaging congenital heart disease (CHD), Asian doctors have not only made every effort to adhere to established magnetic resonance imaging (MRI) protocols as in Western countries, but also have developed Computed tomography (CT) as an alternative problem-solving technique. Databases have shown that Asian doctors were more inclined to utilize CT than MRI in evaluating CHD. Articles in the literature focusing on CT have been cited more frequently than articles on MRI. Additionally, several repeatedly cited CT articles have become seminal papers in this field. The database reflects a trend suggesting that Asian doctors actively adapt to new techniques and flexibly develop unique strategies to overcome limitations caused by the relatively limited resources often available to them.
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Kim HJ, Goo HW, Park SH, Yun TJ. Left ventricle volume measured by cardiac CT in an infant with a small left ventricle: a new and accurate method in determining uni- or biventricular repair. Pediatr Radiol 2013; 43:243-6. [PMID: 22875206 DOI: 10.1007/s00247-012-2464-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 06/24/2012] [Accepted: 07/08/2012] [Indexed: 10/28/2022]
Abstract
Left ventricle volume is a factor in determining the type of surgical treatment in patients with a hypoplastic left ventricle. The volume of the hypoplastic left ventricle can be measured by echocardiography and cardiac MRI. In an infant with congenital heart disease and a small left ventricle, cardiac CT was used for this measurement and biventricular repair was performed. The left ventricular end-diastolic volume index showed a gradual increase from 23.2 to 47.9 ml/m(2) 4 months after the biventricular repair, and the postoperative outcome was excellent. Cardiac CT provided an accurate volume of the hypoplastic left ventricle in this infant with congenital heart disease; that volume was used to determine the type of surgical repair.
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Affiliation(s)
- Ho Jin Kim
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Sun K, Han RJ, Ma LJ, Wang LJ, Li LG, Chen JH. Prospectively electrocardiogram-gated high-pitch spiral acquisition mode dual-source CT coronary angiography in patients with high heart rates: comparison with retrospective electrocardiogram-gated spiral acquisition mode. Korean J Radiol 2012; 13:684-93. [PMID: 23118566 PMCID: PMC3484288 DOI: 10.3348/kjr.2012.13.6.684] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/02/2012] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode. MATERIALS AND METHODS Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 ± 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed. RESULTS There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 ± 0.306 [group A] vs. 1.084 ± 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 ± 0.16 mSv in group A and 7.1 ± 1.05 mSv in group B (p = 0.001). CONCLUSION In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.
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Affiliation(s)
- Kai Sun
- Department of Radiology, Baotou Central Hospital, Inner Mongolia, Baotou 014040, China.
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74
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The value of low-dose prospective ECG-gated dual-source CT angiography in the diagnosis of coarctation of the aorta in infants and children. Clin Radiol 2012; 67:738-45. [DOI: 10.1016/j.crad.2011.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/10/2011] [Accepted: 12/19/2011] [Indexed: 11/20/2022]
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75
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Coronary sinus ostial atresia with persistent left superior vena cava demonstrated on cardiac CT in an infant with a functional single ventricle. Pediatr Radiol 2012; 42:761-3. [PMID: 21993993 DOI: 10.1007/s00247-011-2258-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 08/05/2011] [Accepted: 08/07/2011] [Indexed: 10/16/2022]
Abstract
Coronary sinus ostial atresia (CSOA) with persistent left superior vena cava (PLSVC) is a rare cardiovascular anomaly. Although usually asymptomatic, it is of critical importance to recognize this anomaly before cardiac surgery, particularly in patients with a functional single ventricle because ligation or division of the PLSVC may lead to lethal myocardial edema, ischemia and necrosis. To the best of our knowledge, preoperative recognition of this anomaly on cardiac CT has not been reported. We report an infant with functional single ventricle in whom CSOA and PLSVC were successfully demonstrated on preoperative cardiac CT.
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76
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Accuracy, image quality and radiation dose comparison of high-pitch spiral and sequential acquisition on 128-slice dual-source CT angiography in children with congenital heart disease. Eur Radiol 2012; 22:2057-66. [DOI: 10.1007/s00330-012-2479-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/19/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
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77
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MCLAREN CLAREA, ROEBUCK DEREKJ. Imaging tracheobronchomalacia in the 21st century. J Med Imaging Radiat Oncol 2012; 56:129-31. [DOI: 10.1111/j.1754-9485.2012.02357.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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78
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Sarantopoulos A, Beziere N, Ntziachristos V. Optical and Opto-Acoustic Interventional Imaging. Ann Biomed Eng 2012; 40:346-66. [DOI: 10.1007/s10439-011-0501-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/23/2011] [Indexed: 12/20/2022]
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de Mello RA, Magalhães A, Vilas-Boas AJ. Stridor and respiratory failure due to tracheobronchomalacia: case report and review of the literature. SAO PAULO MED J 2012; 130:61-4. [PMID: 22344362 PMCID: PMC10906683 DOI: 10.1590/s1516-31802012000100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 12/20/2010] [Accepted: 06/14/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Tracheobronchomalacia (TBM) results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of the trachea and main bronchi. In this paper, we present a rare case of a patient with TBM who first presented with stridor and respiratory failure due to exacerbation of chronic bronchitis. CASE REPORT An 81-year-old Caucasian man was admitted presenting coughing, purulent sputum, stridor and respiratory failure. He had a medical history of chronic obstructive pulmonary disease (COPD) and silicosis and was a former smoker. Axial computed tomography on the chest revealed marked collapse of the trachea in its middle third. Bronchoscopy showed characteristics compatible with TBM. He was treated with noninvasive ventilation, without any good response. Subsequently, a Dumon Y stent was placed by means of rigid bronchoscopy. After the procedure, he was discharged with a clinical improvement. CONCLUSION TBM is fatal and often underdiagnosed. In COPD patients, stridor and respiratory failure may be helpful signs that should alert physicians to consider TBM as an early diagnosis. Thus, these signs may be important for optimizing the treatment and evolution of such patients.
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80
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Goo HW. CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol 2011; 13:1-11. [PMID: 22247630 PMCID: PMC3253393 DOI: 10.3348/kjr.2012.13.1.1] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/18/2011] [Indexed: 11/29/2022] Open
Abstract
In keeping with the increasing utilization of CT examinations, the greater concern about radiation hazards from examinations has been addressed. In this regard, CT radiation dose optimization has been given a great deal of attention by radiologists, referring physicians, technologists, and physicists. Dose-saving strategies are continuously evolving in terms of imaging techniques as well as dose management. Consequently, regular updates of this issue are necessary especially for radiologists who play a pivotal role in this activity. This review article will provide an update on how we can optimize CT dose in order to maximize the benefit-to-risk ratio of this clinically useful diagnostic imaging method.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
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81
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Cardiac computed tomography and conventional angiography in the diagnosis of congenital cardiac disease in children: recent trends and radiation doses. Cardiol Young 2011; 21:616-22. [PMID: 21733206 DOI: 10.1017/s1047951111000485] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The use of imaging that employs ionising radiation is increasing in the setting of paediatric cardiology. Children's high radiosensitivity and the lack of contemporary radiation data warrant a review of the radiation doses from the latest "state-of-the-art" angiography and computed tomography systems. OBJECTIVES In children aged less than 16 years with congenital cardiac disease, we aimed to report: recent trends in the use of diagnostic angiography and cardiac dual-source computed tomography; the characteristics, lesions, and imaging histories of patients undergoing these procedures; and the average radiation doses imparted by each modality. STUDY DESIGN Retrospective review of consecutive cases undergoing cardiac computed tomography or diagnostic angiography in a teaching hospital between January, 2008 and December, 2009. Radiation doses were converted to effective doses (millisievert) using published conversion factors. RESULTS Angiography was performed 3.7 times more often than computed tomography. Computed tomography examinations increased by 92.5%, whereas angiography decreased by 26.4% in 2009 compared with 2008. Patients undergoing computed tomography were younger and weighed less than those undergoing angiography, but lesions were similar between the 2 groups. Multiple lifetime angiography was more prevalent than multiple lifetime computed tomography (p < 0.001). The median procedural dose - range - from angiography and computed tomography was 5 (0.2-27.8) and 1.7 (0.5-9.5) millisieverts, respectively (p < 0.001). CONCLUSION Despite not being completely analogous investigations, computed tomography should be considered prior to angiography and not withheld on radiation dose concerns, given that it imparts lower and more consistent doses than conventional angiography.
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Abstract
Cardiac multidetector computed tomography (MDCT) for congenital heart disease is a useful, rapid, and noninvasive imaging technique bridging the gaps between echocardiography, cardiac catheterization, and cardiac MRI. Fast scan speed and greater anatomic coverage, combined with flexible ECG-synchronized scans and a low radiation dose, are critical for improving the image quality of cardiac MDCT and minimizing patient risk. Current MDCT techniques can accurately evaluate extracardiac great vessels, lungs, and airways, as well as coronary arteries and intracardiac structures. Radiologists who perform cardiac MDCT in children should be familiarized with optimal cardiac computed tomography (CT) scan techniques and characteristic cardiac CT scan imaging findings.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea.
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83
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Huang MP, Liang CH, Zhao ZJ, Liu H, Li JL, Zhang JE, Cui YH, Yang L, Liu QS, Ivanc TB, Vembar M. Evaluation of image quality and radiation dose at prospective ECG-triggered axial 256-slice multi-detector CT in infants with congenital heart disease. Pediatr Radiol 2011; 41:858-66. [PMID: 21534003 DOI: 10.1007/s00247-011-2079-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/11/2010] [Accepted: 12/11/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are a limited number of reports on the technical and clinical feasibility of prospective electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) in infants with congenital heart disease (CHD). OBJECTIVE To evaluate image quality and radiation dose at weight-based low-dose prospectively gated 256-slice MDCT angiography in infants with CHD. MATERIALS AND METHODS From November 2009 to February 2010, 64 consecutive infants with CHD referred for pre-operative or post-operative CT were included. All were scanned on a 256-slice MDCT system utilizing a low-dose protocol (80 kVp and 60-120 mAs depending on weight: 60 mAs for ≤ 3 kg, 80 mAs for 3.1-6 kg, 100 mAs for 6.1-10 kg, 120 mAs for 10.1-15 kg). RESULTS No serious adverse events were recorded. A total of 174 cardiac deformities, confirmed by surgery or heart catheterization, were studied. The sensitivity of MDCT for cardiac deformities was 97.1%; specificity, 99.4%; accuracy, 95.9%. The mean heart rate during scan was 136.7 ± 14.9/min (range, 91-160) with a corresponding heart rate variability of 2.8 ± 2.2/min (range, 0-8). Mean scan length was 115.3 ± 11.7 mm (range, 93.6-143.3). Mean volume CT dose index, mean dose-length product and effective dose were 2.1 ± 0.4 mGy (range, 1.5-2.8), 24.7 ± 5.9 mGy·cm (range, 14.7-35.8) and 1.6 ± 0.3 mSv (range, 1.1-2.5), respectively. Diagnostic-quality images were achieved in all cases. Satisfactory diagnostic quality for visualization of all/proximal/distal coronary artery segments was achieved in 88.4/98.8/80.0% of the scans. CONCLUSION Low-dose prospectively gated axial 256-slice CT angiography is a valuable tool in the routine clinical evaluation of infants with CHD, providing a comprehensive three-dimensional evaluation of the cardiac anatomy, including the coronary arteries.
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Affiliation(s)
- Mei-ping Huang
- Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, 106 Zhongshan Er Road, Guangzhou, People's Republic of China
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84
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Goo HW. Regional and whole-body imaging in pediatric oncology. Pediatr Radiol 2011; 41 Suppl 1:S186-94. [PMID: 21523595 DOI: 10.1007/s00247-011-2050-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 01/01/2011] [Indexed: 11/29/2022]
Abstract
The goals of tumor imaging include tumor detection, tumor characterization and differential diagnosis, imaging-guided biopsy, evaluation of tumor extent and staging, assessment of treatment responses, and surveillance for residual tumor or tumor recurrence. In clinical practice, various combinations of imaging modalities are used to achieve these goals. Recently introduced tumor imaging methods, such as diffusion MRI, perfusion MRI, whole-body MRI, and positron emission tomography (PET-CT), have shown promising results. Depending on tumor type and management plan, imaging protocols for children should be individually optimized to achieve the shortest examination time, the highest image quality, the lowest risk, and maximum clinical benefits. In this article, the roles of regional and whole-body tumor imaging will be reviewed, and several important issues related to recent technical developments will be discussed.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, South Korea.
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85
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Mo YH, Jaw FS, Wang YC, Jeng CM, Peng SF. Effects of propranolol on the left ventricular volume of normal subjects during CT coronary angiography. Korean J Radiol 2011; 12:319-26. [PMID: 21603291 PMCID: PMC3088849 DOI: 10.3348/kjr.2011.12.3.319] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/16/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study is to determine the effects of propranolol on the left ventricular (LV) volume during CT coronary angiography. MATERIALS AND METHODS The LV volume of 252 normal Chinese subjects (126 subjects with propranolol medication and 126 age- and gender-matched Chinese subjects without medication) was estimated using 64 slices multi-detector CT (MDCT). The heart rate difference was analyzed by the logistic linear regression model with variables that included gender, age, body height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the dosage of propranolol. The following global LV functional parameters were calculated: the real-end diastolic volume (EDV), the real-end systolic volume (ESV) and the real-ejection fraction (EF). RESULTS The female subjects had a greater decrease of heart rate after taking propranolol. The difference of heart rate was negatively correlated with the dosage of propranolol. The real-EDV, the real-ESV and the real-EF ranged from 48.1 to 109 mL/m², 6.1 to 57.1 mL/m² and 41% to 88%, respectively. There was no significant difference in the SBP and DBP between the groups without and with propranolol medication (123 ± 17 and 80 ± 10 mmHg; 120 ± 14 and 80 ± 11 mmHg, respectively). The real-EDV showed no significant difference between these two groups, but the real-ESV and real-EF showed significant differences between these two groups (69.4 ± 9.3 and 70.6 ± 8.9 mL/m²; 23.5 ± 5.7 and 25.6 ± 3.7 mL/m², 66.5 ± 5.1% and 63.5 ± 4.6%, respectively). CONCLUSION The difference of heart rate is significantly influenced by gender and the dosage of propranolol. Propranolol will also increase the ESV, which contributes to a decreased EF, while the SBP, DBP and EDV are not statistically changed.
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Affiliation(s)
- Yuan Heng Mo
- Institute of Biomedical Engineering, College of Engineering and the College of Medicine, National Taiwan University, Taipei, Taiwan
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86
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Stinn B, Stolzmann P, Fornaro J, Hibbeln D, Alkadhi H, Wildermuth S, Leschka S. Technical principles of computed tomography in patients with congenital heart disease. Insights Imaging 2011; 2:349-356. [PMID: 22347958 PMCID: PMC3259356 DOI: 10.1007/s13244-011-0088-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 12/08/2010] [Accepted: 03/10/2011] [Indexed: 11/26/2022] Open
Abstract
Cardiac magnetic resonance imaging and echocardiography are often the primary imaging techniques for many patients with congenital heart disease (CHD). However, with modern generations of CT systems and recent advances in temporal and spatial resolution, cardiac CT has been gaining an increasing reputation in the field of cardiac imaging and in the evaluation of patients with congenital heart disease. The CT imaging protocol depends on the suspected cardiac defect, the type of previous surgical repair, and the patient’s age and level of cooperation. Various strategies are available for reducing radiation exposure, which is of utmost importance particularly in paediatric patients. A sequential segmental analysis is a commonly used approach to analysing congenital heart defects. Familiarity of the performing radiologist with dedicated CT protocols, the complex anatomy, morphology and terminology of CHD, as well as with the surgical procedures used to correct congenital abnormalities is a prerequisite for correct diagnosis.
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Affiliation(s)
- Bjoern Stinn
- Institute of Radiology, General Hospital Saint Gall, Rorschacherstrasse 95, 9007 St Gallen, Switzerland
| | - Paul Stolzmann
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Juergen Fornaro
- Institute of Radiology, General Hospital Saint Gall, Rorschacherstrasse 95, 9007 St Gallen, Switzerland
| | - Dennis Hibbeln
- Institute of Radiology, General Hospital Saint Gall, Rorschacherstrasse 95, 9007 St Gallen, Switzerland
| | - Hatem Alkadhi
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Simon Wildermuth
- Institute of Radiology, General Hospital Saint Gall, Rorschacherstrasse 95, 9007 St Gallen, Switzerland
| | - Sebastian Leschka
- Institute of Radiology, General Hospital Saint Gall, Rorschacherstrasse 95, 9007 St Gallen, Switzerland
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87
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Goo HW. Haemodynamic findings on cardiac CT in children with congenital heart disease. Pediatr Radiol 2011; 41:250-61. [PMID: 21127855 DOI: 10.1007/s00247-010-1886-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/01/2010] [Accepted: 09/19/2010] [Indexed: 12/18/2022]
Abstract
In patients with congenital heart disease, haemodynamic findings demonstrated on cardiac CT might provide useful hints for understanding the haemodynamics of cardiac defects. In contrast to morphological features depicted on cardiac CT, such haemodynamic findings on cardiac CT have not been comprehensively reviewed in patients with congenital heart disease. This article describes normal haemodynamic phenomena of cardiovascular structures and various abnormal haemodynamic findings with their mechanisms and clinical significance on cardiac CT in patients with congenital heart disease.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2 dong, Songpa-gu, Seoul, 138-736, South Korea.
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88
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Young C, Taylor AM, Owens CM. Paediatric cardiac computed tomography: a review of imaging techniques and radiation dose consideration. Eur Radiol 2010; 21:518-29. [PMID: 21188593 DOI: 10.1007/s00330-010-2036-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 12/06/2010] [Accepted: 12/08/2010] [Indexed: 01/10/2023]
Abstract
The significant challenges involved in imaging the heart in small children (<15 kg) have been addressed by, and partially resolved with improvement in temporal and spatial resolution secondary to the advent of new multi-detector CT technology. This has enabled both retrospective and prospective ECG-gated imaging in children even at high heart rates (over 100 bpm) without the need for beta blockers. Recent studies have highlighted that the radiation burden associated with cardiac CT can be reduced using prospective ECG-gating. Our experience shows that the resultant dose reduction can be optimised to a level equivalent to that of a non-gated study. This article reviews the different aspects of ECG-gating and the preferred technique for cardiac imaging in the young child (<15 kg). We summarize our evidenced based recommendations for readers, referencing recent articles and using our in house data, protocols and dose measurements discussing the various methods available for dose calculations and their inherent bias.
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Affiliation(s)
- Carolyn Young
- Cardiorespiratory Unit, UCL Institute of Child Health, London, UK.
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89
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Sánchez Nistal M. Hipertensión pulmonar: aportación de la TCMD al diagnóstico de sus distintos tipos. RADIOLOGIA 2010; 52:500-12. [DOI: 10.1016/j.rx.2010.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/25/2010] [Accepted: 05/29/2010] [Indexed: 11/16/2022]
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90
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Goo HW, Yang DH. Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan. Pediatr Radiol 2010; 40:1670-80. [PMID: 20464385 DOI: 10.1007/s00247-010-1693-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/17/2010] [Accepted: 03/19/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The potential impact of dual-source ECG-triggered sequential CT scan on coronary artery visibility has not been evaluated in free-breathing young children. OBJECTIVE To compare coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT between dual-source ECG-triggered sequential (DSET) scan and single-source non-ECG-synchronized spiral (SSNE) scan. MATERIALS AND METHODS In 93 young children, 108 cardiac 64-slice CT examinations were performed during free-breathing. Visibility of coronary arteries and side branches was compared between SSNE and DSET scans. Heart rates and trigger delays for DSET scan were recorded. Effective dose of each scan technique was calculated. RESULTS Visual grades were significantly higher (P<0.001 or =0.011) on DSET scan than on SSNE scan except for the distal left anterior descending artery. Coronary arteries were traceable in 79.3% on DSET scan and 54.3% on SSNE scan in the overlapped scan range (P<0.0001), and 97.1% and 71.9% for the origins and proximal segments (P<0.0001). Visibility of side branches was improved on DSET scan by a factor of 2.0. Heart rates and trigger delays for DSET scan were 131±24 beats per min and 199±44 ms, respectively. Effective doses of DSET and SSNE scans were 0.36±0.12 mSv and 0.99±0.23 mSv, respectively. CONCLUSION DSET scan improves visibility of coronary arteries on cardiac 64-slice CT in free-breathing young children with congenital heart disease, compared with SSNE scan.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, Korea.
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91
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Sánchez Nistal M. Pulmonary hypertension: The contribution of MDCT to the diagnosis of its different types. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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