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de Lange C, Rodriguez CM, Martinez-Rios C, Lam CZ. Urgent and emergent pediatric cardiovascular imaging. Pediatr Radiol 2024:10.1007/s00247-024-05980-y. [PMID: 38967787 DOI: 10.1007/s00247-024-05980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
The need for urgent or emergent cardiovascular imaging in children is rare when compared to adults. Patients may present from the neonatal period up to adolescence, and may require imaging for both traumatic and non-traumatic causes. In children, coronary pathology is rarely the cause of an emergency unlike in adults where it is the main cause. Radiology, including chest radiography and computed tomography in conjunction with echocardiography, often plays the most important role in the acute management of these patients. Magnetic resonance imaging can occasionally be useful and may be suitable in more subacute cases. Radiologists' knowledge of how to manage and interpret these acute conditions including knowing which imaging technique to use is fundamental to appropriate care. In this review, we will concentrate on the most common cardiovascular emergencies in the thoracic region, including thoracic traumatic and non-traumatic emergencies and pulmonary vascular emergencies, as well as acute clinical disorders as a consequence of primary and postoperative congenital heart disease. This review will cover situations where cardiovascular imaging may be acutely needed, and not strictly emergencies only. Imaging recommendations will be discussed according to the different clinical presentations and underlying pathology.
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Affiliation(s)
- Charlotte de Lange
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Behandlingsvägen 7, 416 50, Gothenburg, Sweden.
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Claudia Martinez-Rios
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Yang Y, Fink N, Emrich T, Graafen D, Richter R, Bockius S, Wolf EV, Laux G, Kavermann L, Müller L, Hell M, Halfmann MC. Optimization of Kernel Type and Sharpness Level Improves Objective and Subjective Image Quality for High-Pitch Photon Counting Coronary CT Angiography. Diagnostics (Basel) 2023; 13:diagnostics13111937. [PMID: 37296789 DOI: 10.3390/diagnostics13111937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Photon-counting detector (PCD) CT offers a wide variety of kernels and sharpness levels for image reconstruction. The aim of this retrospective study was to determine optimal settings for coronary CT angiography (CCTA). (2) Methods: Thirty patients (eight female, mean age 63 ± 13 years) underwent PCD-CCTA in a high-pitch mode. Images were reconstructed using three different kernels and four sharpness levels (Br36/40/44/48, Bv36/40/44/48, and Qr36/40/44/48). To analyze objective image quality, the attenuation, image noise, contrast-to-noise ratio (CNR), and vessel sharpness were quantified in proximal and distal coronaries. For subjective image quality, two blinded readers assessed image noise, visually sharp reproduction of coronaries, and the overall image quality using a five-point Likert scale. (3) Results: Attenuation, image noise, CNR, and vessel sharpness significantly differed across kernels (all p < 0.001), with the Br-kernel reaching the highest attenuation. With increasing kernel sharpness, image noise and vessel sharpness increased, whereas CNR continuously decreased. Reconstruction with Br-kernel generally had the highest CNR (Br > Bv > Qr), except Bv-kernel had a superior CNR at sharpness level 40. Bv-kernel had significantly higher vessel sharpness than Br- and Qr-kernel (p < 0.001). Subjective image quality was rated best for kernels Bv40 and Bv36, followed by Br36 and Qr36. (4) Conclusion: Reconstructions with kernel Bv40 are beneficial to achieve optimal image quality in spectral high-pitch CCTA using PCD-CT.
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Affiliation(s)
- Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Dirk Graafen
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Rosa Richter
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Stefanie Bockius
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Elias V Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Gerald Laux
- Department of Cardiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Larissa Kavermann
- Department of Cardiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
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Influence of heart rate and heart rate variability on the feasibility of ultra-fast, high-pitch coronary photon-counting computed tomography angiography. Int J Cardiovasc Imaging 2023; 39:1065-1073. [PMID: 36773035 PMCID: PMC10160151 DOI: 10.1007/s10554-023-02808-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
Coronary computed tomography angiography has become a mainstay in diagnosing coronary artery disease and is increasingly used in screening symptomatic patients. Recently, photon-counting computed tomography (PCCT) has been introduced into clinical practice, offering higher spatial and temporal resolution. As the applied radiation dose is highly dependent on the choice of scan mode and is lowest using the ultra-fast high-pitch (FLASH) mode, guidelines for their application are needed. From a retrospective study investigating the properties of a novel photon-counting computed tomography, all patients who underwent FLASH-mode PCCT angiography were selected between January and April 2022. This resulted in a study population of 46 men and 27 women. We recorded pre- and intrascan ECG readings and calculated heart rate (maximum heart rate 73 bpm) as well heart rate variability (maximum HRV 37 bpm) as measured by the standard deviation of the heart rate. Diagnostic quality and motion artifacts scores were recorded for each coronary artery segment by consensus between two readers. We found a highly significant association between heart rate variability and image quality (p < 0.001). The heart rate itself was not independently associated with image quality. Both heart rate and heart rate variability were significantly associated with the presence of motion artifacts in a combined model. Scan heart rate variability-but not heart rate itself-is a highly significant predictor of reduced image quality on high-pitch coronary photon-counting computed tomography angiography. This may be due to better scanner architecture and an increased temporal resolution compared to conventional energy-integrating detector computed tomography, which has to be addressed in a comparison study in the future.
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Malone LJ, Morin CE, Browne LP. Coronary computed tomography angiography in children. Pediatr Radiol 2022; 52:2498-2509. [PMID: 34734316 PMCID: PMC8566193 DOI: 10.1007/s00247-021-05209-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022]
Abstract
Imaging the coronary arteries of children, with their faster heart rates, small vessel size and common inability to lie still or breath-hold, has been a major challenge. With numerous advances in technology, CT examinations can now be performed quickly, often with children free-breathing and with much lower radiation doses than previously. This has led to increased use in children. Care must be taken with technique and choice of electrocardiogram (ECG)-gating technique to obtain adequate imaging for a diagnosis while keeping radiation dose as low as reasonably achievable (ALARA). In this paper, we discuss techniques and tips for CT imaging of the coronary arteries in children, including use of dual-source- and ultrawide-detector CT scanners.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, University of Colorado, Aurora, CO, USA.
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA.
| | - Cara E Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado, Aurora, CO, USA
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA
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