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Gulizia M, Alamo L, Alemán-Gómez Y, Cherpillod T, Mandralis K, Chevallier C, Tenisch E, Viry A. Gated cardiac CT in infants: What can we expect from deep learning image reconstruction algorithm? J Cardiovasc Comput Tomogr 2024; 18:304-306. [PMID: 38480035 DOI: 10.1016/j.jcct.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND ECG-gated cardiac CT is now widely used in infants with congenital heart disease (CHD). Deep Learning Image Reconstruction (DLIR) could improve image quality while minimizing the radiation dose. OBJECTIVES To define the potential dose reduction using DLIR with an anthropomorphic phantom. METHOD An anthropomorphic pediatric phantom was scanned with an ECG-gated cardiac CT at four dose levels. Images were reconstructed with an iterative and a deep-learning reconstruction algorithm (ASIR-V and DLIR). Detectability of high-contrast vessels were computed using a mathematical observer. Discrimination between two vessels was assessed by measuring the CT spatial resolution. The potential dose reduction while keeping a similar level of image quality was assessed. RESULTS DLIR-H enhances detectability by 2.4% and discrimination performances by 20.9% in comparison with ASIR-V 50. To maintain a similar level of detection, the dose could be reduced by 64% using high-strength DLIR in comparison with ASIR-V50. CONCLUSION DLIR offers the potential for a substantial dose reduction while preserving image quality compared to ASIR-V.
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Affiliation(s)
- Marianna Gulizia
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Leonor Alamo
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Yasser Alemán-Gómez
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Tyna Cherpillod
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Katerina Mandralis
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Christine Chevallier
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Estelle Tenisch
- Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Anaïs Viry
- Institute of Radiation Physics, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Grand Pré 1, 1007 Lausanne, Switzerland.
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Wheen PR, Corden B, Nazir MS, Rubens MB, Semple TR, Nicol ED. Intracardiac shunt assessment using CT coronary angiography. J Cardiovasc Comput Tomogr 2023; 17:436-444. [PMID: 37865534 DOI: 10.1016/j.jcct.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Detection of intracardiac shunts using CT Coronary Angiography (CTCA) is currently based on anatomical demonstration of defects. We assessed a novel technique using a standard CTCA test bolus in detecting shunts independent of anatomical assessment and to provide an estimate of Qp/Qs. METHODS We retrospectively reviewed 51 CTCAs: twenty-one from patients with known simple left to right intracardiac shunts with contemporaneous functional assessment (using CMR) within 6 months, 20 controls with structurally normal hearts, and 10 patients with shunt repairs. From the dynamic acquisition of a test bolus, we measured mean Hounsfield Units (HU) in various anatomical structures. We created time/density curves from the test bolus data, and calculated disappearance time (DT) from the ascending aorta (deriving a Qp/Qs), peak ascending aortic HU, and mean coefficient of variation of the arterial curves, and compared these with the Qp/Qs from the respective CMR. RESULTS Patients with intracardiac shunts had significantly higher test bolus derived Qp/Qs compared with both the controls, and the repaired shunt comparator group. There was a very strong agreement between the test bolus derived Qp/Qs, and Qp/Qs as measured by CMR (Intraclass correlation 0.89). Mean bias was 0.032 ± 0.341 (95% limits of agreement -0.64 to 0.70). Interobserver, and intraobserver agreement of the disappearance time was excellent (0.99, 0.99 (reader 1) and 1.00 (reader 2) respectively). CONCLUSION In this proof-of-concept study, we demonstrate a novel technique to detect, and to estimate severity of left to right intracardiac shunts on routine Cardiac CT.
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Affiliation(s)
- Peter R Wheen
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK.
| | - Ben Corden
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Muhummad Sohaib Nazir
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Michael B Rubens
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Thomas R Semple
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Edward D Nicol
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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Addison D, Neilan TG, Barac A, Scherrer-Crosbie M, Okwuosa TM, Plana JC, Reding KW, Taqueti VR, Yang EH, Zaha VG. Cardiovascular Imaging in Contemporary Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1271-1286. [PMID: 37732422 DOI: 10.1161/cir.0000000000001174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Advances in cancer therapeutics have led to dramatic improvements in survival, now inclusive of nearly 20 million patients and rising. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Advances in cardiovascular imaging have solidified the critical role for robust methods for detecting, monitoring, and prognosticating cardiac risk among patients with cancer. However, decentralized evaluations have led to a lack of consensus on the optimal uses of imaging in contemporary cancer treatment (eg, immunotherapy, targeted, or biological therapy) settings. Similarly, available isolated preclinical and clinical studies have provided incomplete insights into the effectiveness of multiple modalities for cardiovascular imaging in cancer care. The aims of this scientific statement are to define the current state of evidence for cardiovascular imaging in the cancer treatment and survivorship settings and to propose novel methodological approaches to inform the optimal application of cardiovascular imaging in future clinical trials and registries. We also propose an evidence-based integrated approach to the use of cardiovascular imaging in routine clinical settings. This scientific statement summarizes and clarifies available evidence while providing guidance on the optimal uses of multimodality cardiovascular imaging in the era of emerging anticancer therapies.
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Beer M, Schönnagel B, Herrmann J, Klömpken S, Schaal M, Kaestner M, Apitz C, Brunner H. Non-invasive pediatric cardiac imaging-current status and further perspectives. Mol Cell Pediatr 2022; 9:21. [PMID: 36575291 PMCID: PMC9794482 DOI: 10.1186/s40348-022-00153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Non-invasive cardiac imaging has a growing role in diagnosis, differential diagnosis, therapy planning, and follow-up in children and adolescents with congenital and acquired cardiac diseases. This review is based on a systematic analysis of international peer-reviewed articles and additionally presents own clinical experiences. It provides an overview of technical advances, emerging clinical applications, and the aspect of artificial intelligence. MAIN BODY The main imaging modalities are echocardiography, CT, and MRI. For echocardiography, strain imaging allows a novel non-invasive assessment of tissue integrity, 3D imaging rapid holistic overviews of anatomy. Fast cardiac CT imaging new techniques-especially for coronary assessment as the main clinical indication-have significantly improved spatial and temporal resolution in adjunct with a major reduction in ionizing dose. For cardiac MRI, assessment of tissue integrity even without contrast agent application by mapping sequences is a major technical breakthrough. Fetal cardiac MRI is an emerging technology, which allows structural and functional assessment of fetal hearts including even 4D flow analyses. Last but not least, artificial intelligence will play an important role for improvements of data acquisition and interpretation in the near future. CONCLUSION Non-invasive cardiac imaging plays an integral part in the workup of children with heart disease. In recent years, its main application congenital heart disease has been widened for acquired cardiac diseases.
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Affiliation(s)
- Meinrad Beer
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Björn Schönnagel
- grid.13648.380000 0001 2180 3484Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- grid.13648.380000 0001 2180 3484Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Klömpken
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Matthias Schaal
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Michael Kaestner
- grid.410712.10000 0004 0473 882XDivision of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Christian Apitz
- grid.410712.10000 0004 0473 882XDivision of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Horst Brunner
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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Sakrana AA, Alharbi IH, Elmokadem AH. Diagnostic accuracy of lower-dose cardiac CT in evaluating young infants with non-coronary complex congenital heart disease on a 64-slice multidetector CT scanner. Acta Radiol 2022; 64:2024-2032. [PMID: 36451522 DOI: 10.1177/02841851221139672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Redoable precise and non-invasive diagnostic imaging modality with the least radiation dose is essential for infants with congenital heart disease (CHD) . Purpose To investigate the accuracy and estimate the radiation dose of our cardiac computed tomography (CCT) protocol. Material and Methods A total of 82 infants with CHD underwent non-ECG-gated CCT without contrast timing scanning techniques and were retrospectively studied. The image quality and radiation dose were estimated. The radiation dose was compared statistically to virtual retrospective ECG-gated and prospective ECG-triggering scanning modes. The diagnostic accuracy was assessed assuming the surgical results as the diagnostic gold standard. Results Most exams showed a high quality with low radiation doses compared to previous studies. The mean effective dose (ED) was 0.39 ± 1.2, significantly lower than that of the virtual retrospective ECG-gated and prospective ECG-triggering scanning and lower than in previous studies. Our CCT protocol has achieved a diagnostic accuracy of 99.52% with a sensitivity of 94.83% and specificity of 99.91%. Conclusion Non-ECG-gated CCT without contrast timing techniques can detect the non-coronary cardiovascular defects of CHD in infants with an ultralow radiation dose and a high diagnostic accuracy.
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Affiliation(s)
- Amal Abdelsattar Sakrana
- Department of Diagnostic and Interventional radiology, Mansoura University Hospital, Mansoura, Egypt
| | | | - Ali H Elmokadem
- Department of Diagnostic and Interventional radiology, Mansoura University Hospital, Mansoura, Egypt
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Semalti K, Sharma V, Kumar V, Aneja S, Simalti AK, Malik A. Dual phase multidetector computed tomography angiography in evaluation of pulmonary arteries and collateral vessels in children with cyanotic congenital heart diseases. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Hustings N, Bosmans H, Dymarkowski S. PURSUING OPTIMAL RADIATION DOSE IN PEDIATRIC CARDIAC CT: A REPORT FROM UNIVERSITY HOSPITAL LEUVEN. RADIATION PROTECTION DOSIMETRY 2022; 198:139-146. [PMID: 35137188 DOI: 10.1093/rpd/ncac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Computed tomography (CT) balances between high resolution and low radiation dose. Given the greater radiosensitivity of children, it is appropriate to use child-friendly CT-protocols that reduce radiation dose at acceptable image quality.This article states the radiation dose in pediatric cardiac CT-examinations at university hospital Leuven (Belgium) and compares with findings published by similar medical centers. The diagnostic accuracy was simultaneously compared, as it correlates with radiation dose. MATERIAL AND METHODS his retrospective observational study analyzed 58 CT-scans of 52 patients. The radiation dose was calculated in effective dose. The image quality was scored qualitatively with a 5-point scale. The diagnostic accuracy, a derivative representation of the image quality, was checked with findings from surgery or conventional angiography. RESULTS The mean effective dose in our study population was 1.3 ± 0.4 mSv. The qualitative image quality was on average 'good', elaborated with a score of 4.0 ± 0.2. The diagnostic accuracy was 92%. Comparative literature study provides a mean effective dose of 1.5 mSv and the reported diagnostic accuracy from other centers reaches ≥90%. CONCLUSIONS At our center pediatric cardiac CT-scans are obtained with good-to-excellent image quality and high diagnostic accuracy at low radiation doses. These results meet the radiation dose and diagnostic accuracy as published by comparable medical centers.
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Affiliation(s)
- Nico Hustings
- Radiology Resident in University Hospital of Leuven, University Hospital of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Hilde Bosmans
- Medical Physics and Quality Control in University Hospital of Leuven, University Hospital of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Steven Dymarkowski
- Radiologist in University Hospital of Leuven, University Hospital of Leuven, Herestraat 49, Leuven 3000, Belgium
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Adebo DA, Schoeneberg L. Dual-source and prospective gated low dose neonatal cardiac computed tomography in evaluation of congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2021.101447] [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: 11/16/2022]
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Yamasaki Y, Kamitani T, Sagiyama K, Matsuura Y, Hida T, Nagata H. Model-based iterative reconstruction for 320-detector row CT angiography reduces radiation exposure in infants with complex congenital heart disease. ACTA ACUST UNITED AC 2021; 27:42-49. [PMID: 33290239 DOI: 10.5152/dir.2020.19633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We investigated the impact of model-based iterative reconstruction (MBIR) on 320-detector row computed tomography angiography (CTA) in infants with complex congenital heart disease (CHD). METHODS Seventy infants with complex CHD who underwent 320-detector row CTA (40 boys and 30 girls; age range, 0-22 months; median age, 60 days) were retrospectively evaluated. First, the images were reconstructed by filtered back projection (FBP), hybrid iterative reconstruction (HIR), or MBIR in 20 cases, and variables were compared among the three iterative reconstruction methods (IR test). Second, the variables were compared between 25 cases scanned using HIR and 25 cases scanned using MBIR, with a 20 standard deviation noise level for both. Attenuation values and contrast-to-noise ratios (CNRs) of the great vessels and heart chambers were calculated. Total dose-length products were recorded for all patients (radiation dose: RD test). RESULTS In the IR test, the mean CNR values were 4.8±1.3 for FBP, 6.9±1.4 for HIR, and 8.2±1.7 for MBIR (P < 0.0001). The best subjective image qualities in the great vessels and heart chambers were obtained with MBIR. In RD testing, no significant differences between HIR and MBIR in image quality (CNR: HIR, 8.4±2.4; MBIR, 8.3±2.4) were observed. The effective dose was significantly lower for MBIR than for HIR (0.7±0.2 vs. 1.1±0.3 mSv; P < 0.001). CONCLUSION The MBIR algorithm significantly improved image quality and decreased radiation exposure in 320-row CTA of infants with complex CHD, providing an alternative to FBP or HIR that is both safer and produces better results.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Matsuura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Öztürk E, Tanıdır İC, Kamalı H, Ayyıldız P, Topel C, Selen Onan İ, Türkvatan A, Haydin S, Güzeltaş A. Comparison of echocardiography and 320-row multidetector computed tomography for the diagnosis of congenital heart disease in children. Rev Port Cardiol 2021; 40:583-590. [PMID: 34392902 DOI: 10.1016/j.repce.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/11/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Echocardiography (echo) is the primary non-invasive imaging modality for the assessment of congenital heart disease (CHD). Computed tomography angiography (CTA) also has potential to examine the anatomy of complex heart anomalies as well as extracardiac involvement. OBJECTIVES The aim of this study is to determine the impact of new CTA technology in the diagnosis of CHD and to compare echo and CTA in terms of diagnostic accuracy. METHODS Forty-five patients who underwent preoperative echo and CTA assessment in the intensive care unit were included in this study. The results were assessed for three main types of CHD (cardiac malformations, cardiac-major vessel connections and major vessels). The main groups were also divided into subgroups according to surgical features in order to assess them more objectively. Imaging methods were compared for diagnostic accuracy, sensitivity and specificity, while surgical findings were accepted as the gold standard. RESULTS Patients' median age and weight were two months (three days-eight years) and 12 kg (2.5-60 kg), respectively. In 45 operated cases, 205 subgroup malformations were assessed. Diagnostic accuracy was significantly greater in echo (echo vs. CTA: 98.4% and 96.2% [chi-square=6.4, p=0.011]). During surgery, 84 cardiac malformations (echo vs. CTA: 97.4% and 95.1% [chi-square=4.9, p=0.03]), 47 cardiac-major vessel connections (echo vs. CTA: 98.3% and 95.4% [chi-square=7.5, p=0.03]), and 74 major vessel malformations (echo vs. CTA: 96% and 98% [chi-square=1.8, p=0.48]) were confirmed. CONCLUSION Echocardiography and CTA are imaging methods with high diagnostic accuracy in children with CHD. The use of echocardiography together with CTA, especially for the visualization of extracardiac anatomy, provides additional information for clinicians.
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Affiliation(s)
- Erkut Öztürk
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.
| | - İbrahim Cansaran Tanıdır
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Hacer Kamalı
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Pelin Ayyıldız
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Cagdas Topel
- Department of Radyology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - İsmihan Selen Onan
- Department of Cardiovascular Surgery, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Aysel Türkvatan
- Department of Radyology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Sertaç Haydin
- Department of Cardiovascular Surgery, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Comparison of echocardiography and 320-row multidetector computed tomography for the diagnosis of congenital heart disease in children. Rev Port Cardiol 2021. [PMID: 34120823 DOI: 10.1016/j.repc.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Echocardiography (echo) is the primary non-invasive imaging modality for the assessment of congenital heart disease (CHD). Computed tomography angiography (CTA) also has potential to examine the anatomy of complex heart anomalies as well as extracardiac involvement. OBJECTIVES The aim of this study is to determine the impact of new CTA technology in the diagnosis of CHD and to compare echo and CTA in terms of diagnostic accuracy. METHODS Forty-five patients who underwent preoperative echo and CTA assessment in the intensive care unit were included in this study. The results were assessed for three main types of CHD (cardiac malformations, cardiac-major vessel connections and major vessels). The main groups were also divided into subgroups according to surgical features in order to assess them more objectively. Imaging methods were compared for diagnostic accuracy, sensitivity and specificity, while surgical findings were accepted as the gold standard. RESULTS Patients' median age and weight were two months (three days-eight years) and 12 kg (2.5-60 kg), respectively. In 45 operated cases, 205 subgroup malformations were assessed. Diagnostic accuracy was significantly greater in echo (echo vs. CTA: 98.4% and 96.2% [chi-square=6.4, p=0.011]). During surgery, 84 cardiac malformations (echo vs. CTA: 97.4% and 95.1% [chi-square=4.9, p=0.03]), 47 cardiac-major vessel connections (echo vs. CTA: 98.3% and 95.4% [chi-square=7.5, p=0.03]), and 74 major vessel malformations (echo vs. CTA: 96% and 98% [chi-square=1.8, p=0.48]) were confirmed. CONCLUSION Echocardiography and CTA are imaging methods with high diagnostic accuracy in children with CHD. The use of echocardiography together with CTA, especially for the visualization of extracardiac anatomy, provides additional information for clinicians.
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Kumar P, Bhatia M. Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle. J Cardiovasc Imaging 2021; 29:205-227. [PMID: 34080329 PMCID: PMC8318812 DOI: 10.4250/jcvi.2020.0196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 01/22/2023] Open
Abstract
Double-outlet right ventricle (DORV) is a type of ventriculoarterial connection in which both great arteries arise entirely or predominantly from the right ventricle. The morphology of DORV is characterized by a ventricular septal defect (location and relationship with the semilunar valve); bilateral coni and aortomitral continuity; the presence or absence of outflow tract obstruction; tricuspid-pulmonary annular distance; and associated cardiac anomalies. The surgical approach varies with the type of DORV and is based on multiple variables. Computed tomography (CT) is a robust diagnostic tool for the preoperative and postoperative assessment of DORV. Unlike echocardiography and magnetic resonance imaging (MRI), CT imaging is not limited by small acoustic window, need for anaesthesia and can be used in patients with metallic implants. Current generations CT scanners with high spatial and temporal resolution, wide detectors, high-pitch scanning mode, dose-reduction algorithms, and advanced three-dimensional post-processing tools provide a low-risk, high-quality alternative to diagnostic cardiac catheterization or MRI, and have been increasingly utilized in nearly every type of congenital heart defect, including DORV.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, New Delhi, India.
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, New Delhi, India.,Cardiological Society of India, Kolkata, India.,International Regional Committee, India Chapter of the Society of Cardiovascular Computed Tomography, New Delhi, India
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Nunes MDO, Witt DR, Casey SA, Stanberry LI, Caye DJ, J Chu B, Lindberg BJ, Lesser JR, Han BK. Safety, Efficacy, and Dose Protocol of Metoprolol for Heart Rate Reduction in Pediatric Outpatients Undergoing Cardiac CT Angiography. Arq Bras Cardiol 2021; 116:100-105. [PMID: 33566972 PMCID: PMC8159495 DOI: 10.36660/abc.20190892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/05/2020] [Indexed: 11/28/2022] Open
Abstract
Fundamento Qualidade de imagem e dose de radiação são otimizadas com uma frequência cardíaca (FC) lenta e estável na realização de imagens de artérias coronárias durante a angiografia cardíaca por tomografia computadorizada (CCTA, do inglês
cardiac computed tomography angiography
) A segurança, a eficácia e o protocolo para a redução da FC com medicamento betabloqueador ainda não foi bem descrita em uma população de pacientes pediátricos. Objetivo Oferecer um protocolo de dose de metoprolol eficiente a ser usado em pacientes pediátricos externos durante a CCTA. Métodos Realizamos uma revisão retrospectiva de todos os pacientes pediátricos externos que receberam o metoprolol durante a CCTA. As características demográficas e clínicas foram resumidas e a redução média em FC foi estimada utilizando-se um modelo de regressão linear multivariada. As imagens foram avaliadas em uma escala de 1 a 4 (1= ideal). Resultados Um total de 78 pacientes externos passaram a uma CCTA com o uso de metoprolol. A média de idade foi de 13 anos, a média de peso foi de 46 kg, e 36 pacientes (46%) eram do sexo masculino. As doses médias de metoprolol foram 1,5 (IQR 1,1; 1,8) mg/kg, e 0,4 (IQR 0,2; 0,7) mg/kg para administrações orais e intravenosas, respectivamente. O produto dose-comprimento por exame foi de 57 (IQR 30, 119) mGy*cm. A redução média da FC foi 19 (IQR 12, 26) batimentos por minuto, ou 23%. Não foram relatadas complicações ou eventos adversos. Conclusão O uso de metoprolol num cenário de pacientes pediátricos externos para redução da FC antes de uma CCTA é seguro e eficiente. Pode-se reproduzir um protocolo de dose de metoprolol quando for necessário atingir uma FC mais lenta, garantindo tempos de aquisição mais rápidos, imagens mais claras e redução na exposição à radiação nessa população. (Arq Bras Cardiol. 2021; 116(1):100-105)
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Affiliation(s)
| | - Dawn R Witt
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | - Susan A Casey
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | | | - David J Caye
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | | | | | - John R Lesser
- Minneapolis Heart Institute and Foundation, Minnesota - EUA
| | - B Kelly Han
- Minneapolis Heart Institute and Foundation, Minnesota - EUA.,Children's Minnesota, Minneapolis, Minnesota - EUA
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14
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Multi-institution assessment of the use and risk of cardiovascular computed tomography in pediatric patients with congenital heart disease. J Cardiovasc Comput Tomogr 2021; 15:441-448. [PMID: 33547021 DOI: 10.1016/j.jcct.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known. METHODS Four centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose. RESULTS Cardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 mGy∗cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p < 0.001). Seven minor adverse events (0.7%) and no major adverse events were reported. CONCLUSION Cardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events.
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15
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Evaluation of complex congenital heart disease in infants using low dose cardiac computed tomography. Int J Cardiovasc Imaging 2021; 37:1455-1460. [DOI: 10.1007/s10554-020-02118-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
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16
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Tian L, Wang L, Qin Y, Cai J. Low-dose Computed Tomography (CT) for the Diagnosis of Congenital Heart Disease in Children: A Meta-analysis. Curr Med Imaging 2020; 16:1085-1094. [PMID: 33135610 DOI: 10.2174/1573405616666200107110611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low dose CT has become a promising examination method for the diagnosis of Congenital heart disease (CHD) in children because it has a low radiation dose, but it has not been widely accepted as an alternative to standard-dose CT in clinical applications due to concerns about image quality. Therefore, we suggest that the diagnostic accuracy, image quality, and radiation dose of low-dose CT for CHD in children should be fully explored through a metaanalysis of existing studies. METHODS A comprehensive search was performed to identify relevant English and Chinese articles (from inception to May 2019). All selected studies concerned the diagnosis of CHD in children using low-dose CT. The accuracy of low-dose CT was determined by calculating pooled estimates of sensitivity, specificity, diagnostic odds ratio, and likelihood ratio. Pooling was conducted using a bivariate generalized linear mixed model. Forest plots and summary receiver operating characteristic (SROC) curves were generated. RESULTS Ten studies, accounting for 577 patients, met the eligibility criteria. The pooled sensitivity and specificity were 0.95 (95% confidence interval (CI) 0.92-0.97) and 1.00 (95% CI 1.00- 1.00), respectively. The pooled diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of low-dose CT were 12705.53 (95% CI 5065.00-31871.73), 671.29 (95% CI 264.77- 1701.97), and 0.05 (95% CI 0.03-0.08), respectively. Additionally, the area under the SROC curve was 1.00 (95% CI 0.99-1.00), suggesting that low-dose CT is an excellent diagnostic tool for CHD in children. CONCLUSION Low-dose CT, especially with a prospective ECG-triggering mode, provides excellent imaging quality and high diagnostic accuracy for CHD in children.
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Affiliation(s)
- Lu Tian
- Department of Radiology, Chongqing Medical University, Children's Hospital, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders and Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China
| | - Longlun Wang
- Department of Radiology, Chongqing Medical University, Children's Hospital, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders and Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China
| | - Yong Qin
- Department of Radiology, Chongqing Medical University, Children's Hospital, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders and Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China
| | - Jinhua Cai
- Department of Radiology, Chongqing Medical University, Children's Hospital, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders and Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China
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17
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Image quality and radiation dose of different scanning protocols in DSCT cardiothoracic angiography for children with tetralogy of fallot. Int J Cardiovasc Imaging 2020; 36:1791-1799. [PMID: 32419092 DOI: 10.1007/s10554-020-01882-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study was to investigate the image quality and radiation dose of different scanning protocols in dual-source CT cardiothoracic angiography for children with tetralogy of Fallot (TOF). Seventy-five consecutive children with known or suspected TOF were enrolled to undergo prospective ECG-triggering sequential dual-source CT (DSCT) cardiothoracic angiography. According to the scanning protocols, these patients were randomly divided into 3 groups: fixed delay time (FDT, n = 25, group A), automatic bolus-tracking (ABT, n = 25, group B) and manual bolus-tracking (MBT, n = 25, group C). Subjective and objective image quality were evaluated. The radiation doses were recorded. The image quality scores of group C were significantly higher than those of group A and B. The absolute value of difference (D-value) on CT attenuation between left (CTLV) and right ventricle (CTRV) in group C was significantly lower than that in group A and B. The total effective dose of groups A, B and C were 0.39 ± 0.06 mSv, 0.40 ± 0.07 mSv and 0.40 ± 0.08 mSv, respectively. There was no significant difference among 3 groups (P = 0.722). Scanning protocol has significantly impacts on the image quality of cardiovascular structures for TOF patients. Compared with the conventional scanning protocols FDT and ABT, the MBT technique provides high image quality and achieves more homogenous attenuation among different patients with TOF.
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18
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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19
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Zhang F, Yang L, Gan L, Fan Z, Zhou B, Deng Z, Dey D, Berman DS, Li D, Xie Y. Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke. Stroke 2020; 50:859-866. [PMID: 30879439 DOI: 10.1161/strokeaha.118.023273] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cervicocerebral vascular calcification on computed tomography angiography is a known sign of advanced atherosclerosis. However, the clinical significance of calcification pattern remains unclear. In this study, we aimed to investigate the potential association between spotty calcium and acute ischemic stroke. Methods- This study included patients with first-time nonlacunar ischemic stroke (N=50) confirmed by brain magnetic resonance imaging or nonenhanced head computed tomography, as well as control subjects with asymptomatic carotid atherosclerosis (N=50) confirmed by carotid ultrasonography. Subjects in both groups underwent contrast-enhanced cervicocerebral computed tomography angiography within a week after the initial imaging examination. Spotty calcification was evaluated at 11 arterial segments commonly affected by atherosclerosis along the carotid and vertebrobasilar circulation. Statistical analysis was performed comparing the frequency and spatial pattern of spotty calcification between the 2 groups. Results- Spotty calcification in the Stroke group was markedly more prevalent than that in the Control group (total SC count: 8.74±4.96 versus 1.84±1.82, P<0.001). The odds ratio (95% CI) for stroke was 2.49 (1.55-4.00) for spotty calcification at bilateral carotid bifurcation, 1.52 (1.13-2.04) at carotid siphon, and 1.98 (1.45-2.69) at all evaluated locations. A total number of 3 spotty calcifications were determined as the optimal cutoff threshold for increased risk of stroke. Spotty calcium showed significantly greater area under the receiver operating characteristics curve than total calcium volume irrespective of size (0.88 versus 0.77). Within the Stroke group, ipsilateral lateral side showed significantly more spotty calcium than the contralateral side (5.18±3.05 versus 3.56±2.67, P<0.001). Conclusions- Nonlacunar ischemia stroke was associated with markedly increased incidence of spotty calcification with a distinct spatial pattern on cervicocerebral computed tomography compared with subclinical atherosclerosis, suggesting the potential role of spotty calcification for improving the risk stratification for ischemic stroke.
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Affiliation(s)
- Fan Zhang
- From the Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, China (F.Z.).,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Li Yang
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China (L.Y.)
| | - Lu Gan
- Department of Radiology, Tiantan Hospital, Capital Medical University, Beijing, China (L.G.)
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles.,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Bill Zhou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Zixin Deng
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles.,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
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20
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Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Image Quality of ECG-Triggered High-Pitch, Dual-Source Computed Tomography Angiography for Cardiovascular Assessment in Children. Curr Probl Diagn Radiol 2020; 49:23-28. [DOI: 10.1067/j.cpradiol.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022]
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21
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Zühlke L, Lawrenson J, Comitis G, De Decker R, Brooks A, Fourie B, Swanson L, Hugo-Hamman C. Congenital Heart Disease in Low- and Lower-Middle-Income Countries: Current Status and New Opportunities. Curr Cardiol Rep 2019; 21:163. [PMID: 31784844 DOI: 10.1007/s11886-019-1248-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The paper summarises the most recent data on congenital heart disease (CHD) in low- and lower-middle-income countries (LLMICs). In addition, we present an approach to diagnosis, management and interventions in these regions and present innovations, research priorities and opportunities to improve outcomes and develop new programs. RECENT FINDINGS The reported birth prevalence of CHD in LLMICs is increasing, with clear evidence of the impact of surgical intervention on the burden of disease. New methods of teaching and training are demonstrating improved outcomes. Local capacity building remains the key. There is a significant gap in epidemiological and outcomes data in CHD in LLMICs. Although the global agenda still does not address the needs of children with CHD adequately, regional initiatives are focusing on quality improvement and context-specific interventions. Future research should focus on epidemiology and the use of innovative thinking and partnerships to provide low-cost, high-impact solutions.
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Affiliation(s)
- Liesl Zühlke
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa.
- Division of Cardiology, Department of Medicine, Groote Schur Hospital and University of Cape Town, Cape Town, South Africa.
| | - John Lawrenson
- Western Cape Paediatric Cardiology Services, and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, 7925, South Africa
| | - George Comitis
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
| | - Rik De Decker
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
| | - Andre Brooks
- Chris Barnard Division of Cardiac Surgery, University of Cape Town, Cape Town, South Africa
| | - Barend Fourie
- Western Cape Paediatric Cardiology Services, and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, 7925, South Africa
| | - Lenise Swanson
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
| | - Christopher Hugo-Hamman
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
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22
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Abstract
The assessment of pediatric patients after orthotropic heart transplantation (OHT) relies heavily on non-invasive imaging. Because of the potential risks associated with cardiac catheterization, expanding the role of non-invasive imaging is appealing. Echocardiography is fast, widely available, and can provide an accurate assessment of chamber sizes and function. Advanced echocardiographic methods, such as myocardial deformation, have potential to assess for acute rejection or cardiac allograft vasculopathy (CAV). While not currently part of routine care, cardiac magnetic resonance imaging (CMR) and computed tomography may potentially aid in the detection of graft complications following OHT. In particular, CMR tissue characterization holds promise for diagnosing rejection, while quantitative perfusion and myocardial late gadolinium enhancement may have a role in the detection of CAV. This review will evaluate standard and novel methods for non-invasive assessment of pediatric patients after OHT.
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Affiliation(s)
- Jonathan H Soslow
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Margaret M Samyn
- Medical College of Wisconsin, Pediatrics (Cardiology), Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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23
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Masuda T, Funama Y, Nakaura T, Sato T, Tahara M, Matsumoto Y, Imada N, Miyazaki O, Awai K. Usefulness of diluted contrast medium for test-scanning of infants scheduled for contrast-enhanced cardiovascular computed tomography angiography. Br J Radiol 2019; 92:20180572. [PMID: 30412445 PMCID: PMC6404813 DOI: 10.1259/bjr.20180572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To compare the ability of test scans with undiluted and diluted contrast medium (CM) to predict contrast enhancement (CE) on cardiovascular CT angiography (CCTA) images of infants. METHODS: We divided 120 consecutive infants who had undergone CCTA on a 64-MDCT scanner into two equal groups. In one group, the test bolus consisted of undiluted CM [protocol 1 (P1): injection volume = total body weight × 1.2 ml, injection time 5 s], in the other (P2) it was total body weight × 4.0 ml (CM 15%, saline 85%, injection time 16 s). CE on the test scans was recorded on a 3-point visual scale. We investigated the relation for CE in the pulmonary artery and ascending aorta between the P1 or P2 test scans and CCTA images. RESULTS: While peak CE was observed on all test scans performed with P2, in approximately 10 % of test scans obtained under P1, peak CE was not visualized. There was a strong positive linear correlation for CE of the pulmonary artery and ascending aorta on P2 images (r = 0.61 and r = 0.63, p < 0.01); under P1 the correlation was weak (r = 0.26 and r = 0.33, p < 0.01). CONCLUSION: Test-scanning with diluted CM revealed the optimal CE peak time and was useful for predicting CE on CCTA scans of the pulmonary artery and ascending aorta in infants with congenital heart disease. ADVANCES IN KNOWLEDGE: Diluted test scans help to select the optimal scan parameters for the CCTA study of infants by using contrast-to-noise-based scanning.
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Affiliation(s)
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoyasu Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital, Hiroshima 730-8655, Japan
| | - Masahiro Tahara
- Department of Pediatric Cardiology, Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
| | | | - Naoyuki Imada
- Department of Radiological Technology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Osamu Miyazaki
- Department of Diagnostic Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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24
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Image quality and radiation dose of two prospective ECG-triggered protocols using 128-slice dual-source CT angiography in infants with congenital heart disease. Int J Cardiovasc Imaging 2019; 35:937-945. [DOI: 10.1007/s10554-018-01526-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/31/2018] [Indexed: 11/25/2022]
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25
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Zhang Y, Yang ZG, Yang MX, Shi K, Li R, Diao KY, Guo YK. Common atrium and the associated malformations: Evaluation by low-dose dual-source computed tomography. Medicine (Baltimore) 2018; 97:e12983. [PMID: 30431572 PMCID: PMC6257481 DOI: 10.1097/md.0000000000012983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Common atrium (CA) is a rare complex congenital heart disease. The studies of CA are mostly case reports, while few have been done regarding its morphological characteristics. We aimed to determine CA characteristics and diagnostic accuracy in assessing associated malformations in these patients with low-dose dual-source computed tomography (DSCT).Twenty-one pediatric and adolescent CA patients underwent low-dose DSCT. Different ventricular types and associated malformations were assessed. The diagnostic accuracy of DSCT and transthoracic echocardiography (TTE) in evaluating associated malformations were assessed. The effective doses of DSCT were calculated.Patients (n = 21) were divided into CA with biventricular physiology (n = 7) and CA with single ventricle (SV) (n = 14). There were 3 types of SV morphology: single left ventricle (n = 5), single right ventricle (n = 6), and undifferentiated ventricle (n = 3). In all, 22 associated malformations were seen in CA and 56 in CA with SV. DSCT was superior to TTE for detecting intracardiac anomalies (sensitivity: DSCT, 92.31% vs TTE, 76.92%), great vessels anomalies (sensitivity: DSCT, 100.00% vs TTE, 77.50%), and of collateral vessels (sensitivity: DSCT, 100% vs TTE, 20.00%). The estimated mean effective dose was 0.95 ± 0.44 mSv (<1 mSv).This study indicated that low-dose DSCT is an ideal alternative for pediatric and adolescent patients with CA, providing morphological details of CA and associated malformations with high accuracy.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital
| | | | - Meng-xi Yang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital
| | | | | | | | - Ying-kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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26
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Patient-related factors influencing detectability of coronary arteries in 320-row CT angiography in infants with complex congenital heart disease. Int J Cardiovasc Imaging 2018; 34:1485-1491. [DOI: 10.1007/s10554-018-1363-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/29/2018] [Indexed: 10/17/2022]
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27
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Yamasaki Y, Kawanami S, Kamitani T, Sagiyama K, Shin S, Hino T, Yamamura K, Yabuuchi H, Nagao M, Honda H. Free-breathing 320-row computed tomographic angiography with low-tube voltage and hybrid iterative reconstruction in infants with complex congenital heart disease. Clin Imaging 2018; 50:147-156. [PMID: 29482117 DOI: 10.1016/j.clinimag.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/02/2018] [Accepted: 02/07/2018] [Indexed: 10/18/2022]
Abstract
We explored the clinical value of low-tube voltage prospective second-generation ECG-triggered 320-row CT angiography in infants with complex CHD (37 male, 23 female, aged 0-2 years). The diagnostic accuracy of 320-row CT in complex CHD was 99.4% for intracardiac cardiovascular malformations, 99.8% for extracardiac cardiovascular malformations, and 100% for other malformations. The average subjective overall image quality score for cardiac structures was 3.7 ± 0.5 points. Second-generation 320-row CT angiography with low-tube voltage and prospective ECG-triggered volume target scanning allows accurate diagnosis of cardiovascular anomalies in infants with complex CHD.
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Affiliation(s)
- Yuzo Yamasaki
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Satoshi Kawanami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Seitaro Shin
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
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Rigsby CK, McKenney SE, Hill KD, Chelliah A, Einstein AJ, Han BK, Robinson JD, Sammet CL, Slesnick TC, Frush DP. Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently 'Have-A-Heart' campaign. Pediatr Radiol 2018; 48:5-20. [PMID: 29292481 PMCID: PMC6230472 DOI: 10.1007/s00247-017-3991-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022]
Abstract
Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.
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Affiliation(s)
- Cynthia K Rigsby
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
| | - Sarah E McKenney
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA
| | - Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew J Einstein
- Division of Cardiology, Departments of Medicine and Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - B Kelly Han
- Department of Pediatrics, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Joshua D Robinson
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Sammet
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Timothy C Slesnick
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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Singhal M, Singh S, Gupta P, Sharma A, Khandelwal N, Burns JC. Computed Tomography Coronary Angiography for Evaluation of Children With Kawasaki Disease. Curr Probl Diagn Radiol 2017; 47:238-244. [PMID: 29203262 DOI: 10.1067/j.cpradiol.2017.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to assess the feasibility of computed tomography coronary angiography (CTCA) on a 128-slice, dual source scanner in children with acute and convalescent phase Kawasaki disease (KD). MATERIALS AND METHODS A prospective study of 49 children with KD (12 at presentation and 37 in the convalescent phase) was conducted between November 2013 and April 2015. CTCA was performed with either prospective (n = 37) or retrospective (n = 12) electrocardiographic gating. A radiologist blinded to clinical profile and echocardiogram evaluated each scan. RESULTS Median age (36 boys and 13 girls) was 7 years. Median dose-length product value and median effective CT radiation dose was 32mGycm (interquartile range [IQR]: 21-74) and 0.54 miliSieverts (mSv) (IQR: 0.77-3.2) for all scans, and 27mGycm (IQR: 18.5-33.75) and 0.48mSv (IQR: 0.18-1.17) for prospectively triggered scans (n = 37). Fourteen subjects (30 coronary segments) showed abnormalities by CTCA including aneurysms (n = 27) and stenoses (n = 3). In the acute phase (n = 12), aneurysms were detected in 5 children (18 segments). CONCLUSION CTCA allows comprehensive evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Avinash Sharma
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego (UCSD) School of Medicine and Rady Children's Hospital San Diego, La Jolla, CA
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Yang MX, Yang ZG, Zhang Y, Shi K, Xu HY, Diao KY, Guo YK. Dual-source Computed Tomography for Evaluating Pulmonary Artery and Aorta in Pediatric Patients with Single Ventricle. Sci Rep 2017; 7:13398. [PMID: 29042577 PMCID: PMC5645343 DOI: 10.1038/s41598-017-11809-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/29/2017] [Indexed: 02/05/2023] Open
Abstract
To explore the accuracy of main pulmonary artery (MPA) and ascending aorta (AAO) image evaluation in pediatric patients with single ventricle (SV) by comparing dual-source computed tomography (DSCT) with echocardiography. Thirty-one children with SV were retrospectively enrolled. The stenosis, dilation, and location of MPA and AAO were independently evaluated by DSCT and echocardiography. The accompanying arterial malformations were also assessed by DSCT. For 17 patients undergoing cardiac catheterization, the DSCT-based diameters of MPA and AAO were correlated with their pressures as measured by catheterization. Referring to the surgical and catheterization findings, DSCT had better diagnostic performance in detecting the stenosis, dilation, and location of MPA and AAO with higher sensitivity than echocardiography (sensitivity, MPA: 88.0% vs. 80.0%, AAO: 100% vs. 66.7%, great arteries location: 95.7% vs. 95.2%). The correlations between diameters of MPA and AAO with their pressures were 0.399 (p = 0.04) and 0.611 (p = 0.01), respectively. In addition, DSCT detected 23 cases with patent ductus arteriosus, 26 systemic-to-pulmonary collaterals, 9 branch pulmonary distortions, and 4 coronary artery anomalies. DSCT is reliable for assessing the anatomic features of pulmonary artery and aorta in SV children, and provides comprehensive information for surgical strategy-making.
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Affiliation(s)
- Meng-Xi Yang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China. .,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Yi Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China. .,Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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Li T, Zhao S, Liu J, Yang L, Huang Z, Li J, Luo C, Li X. Feasibility of high-pitch spiral dual-source CT angiography in children with complex congenital heart disease compared to retrospective-gated spiral acquisition. Clin Radiol 2017; 72:864-870. [DOI: 10.1016/j.crad.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/01/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
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Abd El-Rahman HM, Hassan TA, Elfawal MM, Hassan BA, Ali ASA, Abdel-Rahman HM. Role of 128 slice MSCT angiography in evaluation of congenital extra-cardiac intra-thoracic vascular anomalies in children. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Chen XF, Jiang F, Li L, Chen Y, Chen X, Jiang YY, Xiang L, Ma XJ. Application of low-dose dual-source computed tomography angiography in children with complex congenital heart disease. Exp Ther Med 2017; 14:1177-1183. [PMID: 28810576 DOI: 10.3892/etm.2017.4591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 07/21/2016] [Indexed: 11/06/2022] Open
Abstract
The objective of the present study was to evaluate image quality and radiation dosage using a low-dose prospectively electrocardiogram (ECG)-gated computed tomography (CT) protocol for dual-source angiography in children with complex congenital heart disease. A total of 206 patients with complex congenital heart disease were equally assigned into two groups at random. The children in group A underwent low-dose retrospective ECG-gated CT scanning with an ECG-pulsing technique, and group B underwent prospective ECG-gated scanning with an ECG-pulsing technique. Radiation dose volume computed tomography dose index (CTDI vol), dose length product (DLP) and effective dose (ED) were recorded after scanning. Raw data were transferred to workstations for post-processing, diagnosis, grading, comparison with intra-operation findings or cardiac catheterisation, and the coincidence, false negative rate and misdiagnosis rates of groups A and B, respectively, were subsequently recorded. The results of the present study indicated that the height, age and weight of the children in the two groups exhibited no significant differences. The image quality of group A was graded as 3.94±0.08, whereas the grade for the image quality in group B was 4.05±0.08; no significant difference was detected. The coincidence rates of groups A and B were 89.37 and 88.48%, respectively; the false negative rates of groups A and B were 9.66 and 10.60%, respectively; the misdiagnosis rates of groups A and B were 0.97 and 0.92%. No significant differences between the two groups were detected. The CTDI value of group A was 3.24±1.62 mGy, the DLP value was 47.53±33.28 mGy·cm2, the ED value was 0.93±0.42 mSv. By contrast, the CTDI value of group B was 2.27±0.94 mGy, the DLP value was (27.03±17.64) mGy·cm2, and the ED value was 0.53±0.23 mSv. Significant differences were detected between the two groups (CTDI t=5.287, P<0.05; DLP t=5.523, P<0.05; ED t=8.497, P<0.05), and the radiation dose of group B was markedly decreased, compared with group A. In conclusion, the present study demonstrated that prospectively ECG-gated scanning of dual-source CT is an effective method of examination for dose reduction in children with congenital heart disease without impairment of image quality, which suggests that this protocol may be suitable for future application and dissemination.
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Affiliation(s)
- Xian-Feng Chen
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Fan Jiang
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Lin Li
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Yan Chen
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Xin Chen
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Yan-Yan Jiang
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Li Xiang
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
| | - Xiao-Jing Ma
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430000, P.R. China
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Assessment of coronary artery by prospective ECG-triggered 256 multi-slice CT on children with congenital heart disease. Int J Cardiovasc Imaging 2017; 33:2021-2028. [DOI: 10.1007/s10554-017-1150-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/07/2016] [Indexed: 11/26/2022]
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Evaluation of High-Pitch Ungated Pediatric Cardiovascular Computed Tomography for the Assessment of Cardiac Structures in Neonates. J Thorac Imaging 2017; 31:177-82. [PMID: 27007667 DOI: 10.1097/rti.0000000000000201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE We evaluated a high-pitch, non-electrocardiogram-gated cardiac computed tomographic protocol, designed to image both cardiac and extracardiac structures, including coronary arteries, in a neonatal population (less than 1 year old) that was referred for congenital heart disease assessment and compared it with an optimized standard-pitch protocol in an equivalent cohort. MATERIALS AND METHODS Twenty-nine high-pitch scans were compared with 31 age-matched, sex-matched, and weight-matched standard-pitch, dosimetrically equivalent scans. The visualization and subjective quality of both cardiac and extracardiac structures were scored by consensus between 2 trained blinded observers. Image noise, signal-to-noise and contrast-to-noise ratios, and radiation doses were also compared. RESULTS The high-pitch protocol better demonstrated the pulmonary veins (P=0.03) and all coronary segments (all P<0.05), except the distal right coronary artery (P=0.10), with no significant difference in the visualization of the remaining cardiac or extracardiac structures. Both contrast-to-noise and signal-to-noise ratios improved due to greater vessel opacity, with significantly fewer streak (P<0.01) and motion (P<0.01) artifacts. Image noise and computed tomographic dose index were comparable across the 2 techniques; however, the high-pitch acquisition resulted in a small, but statistically significant, increase in dose-length product [13.0 mGy.cm (9.0 to 17.3) vs. 11.0 mGy.cm (9.0 to 13.0), P=0.05] due to greater z-overscanning. CONCLUSIONS In neonates, a high-pitch protocol improves coronary artery and pulmonary vein delineation compared with the standard-pitch protocol, allowing a more comprehensive assessment of cardiovascular anatomy while obviating the need for either patient sedation or heart rate control.
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Koh H, Ong CC, Choo YS, Liang CR, Tan GHZ, Lim TCW, Quek SC, Sriram S, Teo LLS. Radiation Dose and Image Quality in Pediatric Cardiac Computed Tomography: A Comparison Between Sequential and Third-Generation Dual-Source High-Pitch Spiral Techniques. Pediatr Cardiol 2016; 37:1397-1403. [PMID: 27377528 DOI: 10.1007/s00246-016-1447-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate whether there is a reduction in radiation dose and improvement in image quality of pediatric cardiac computed tomography scans performed using the high-pitch spiral technique on a new third-generation dual-source 2 × 192-slice scanner (group B) compared with scans performed using the sequential technique on a single-source 256-slice scanner (group A). We performed a retrospective observational study on 40 patients aged ≤18 years who underwent prospectively electrocardiogram-triggered cardiac computed tomography. Image quality was assessed by pre-defined objective indices and a four-point subjective score. Apart from a higher mean heart rate in group A (P = 0.016), there were otherwise no significant inter-group differences in patient characteristics. The median effective dose was 4.41 mSv (interquartile range 2.58-5.90 mSv) in group A and 0.52 mSv (interquartile range 0.39-0.59 mSv) in group B (P < 0.001), representing a 88 % reduction. Subjective image quality score was significantly better in group B (4 = excellent with no artifact, mode 57.1 %) than in group A (3 = good with mild artifact, mode 57.9 %) (P < 0.001). Noise index, signal-to-noise ratio and contrast-to-noise ratio between both groups were not statistically significant. New third-generation dual-source high-pitch spiral scan technique can deliver excellent image quality with low radiation dose. Our results suggest that it should be considered as a first-choice technique for performing cardiac computed tomography in the pediatric population.
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Affiliation(s)
- Huiliang Koh
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Yun Song Choo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Grace Hui Zhen Tan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Terence Chee Wen Lim
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Swee Chye Quek
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Shankar Sriram
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
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Prospective ECG-gated high-pitch dual-source cardiac CT angiography in the diagnosis of congenital cardiovascular abnormalities: Radiation dose and diagnostic efficacy in a pediatric population. Diagn Interv Imaging 2016; 97:1141-1150. [DOI: 10.1016/j.diii.2016.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/19/2016] [Accepted: 03/25/2016] [Indexed: 11/21/2022]
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Bu G, Miao Y, Bin J, Deng S, Liu T, Jiang H, Chen W. Comparison of 128-Slice Low-Dose Prospective ECG-Gated CT Scanning and Trans-Thoracic Echocardiography for the Diagnosis of Complex Congenital Heart Disease. PLoS One 2016; 11:e0165617. [PMID: 27788237 PMCID: PMC5082860 DOI: 10.1371/journal.pone.0165617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To compare prospective ECG-gated multi-slice computed tomography (MSCT) and trans-thoracic echocardiography (TTE) in the diagnosis of complex congenital heart disease (CHD). Methods This was a prospective study of consecutive patients with complex CHD (age <7 years) treated at a tertiary hospital between May 2013 and May 2015. All patients were imaged with TTE and prospective ECG-gated 128-slice spiral CT in the week before surgery. Effective radiation dose (ED) was calculated from volume CT dose index (CTDIvol) and dose length product (DLP). Image quality (5-point scale) was assessed independently by two radiologists. Using surgical findings as the reference, the diagnostic capabilities of MSCT and TTE were compared. Results Thirty-five patients (19 males) aged 1.59±1.58 years (range, 3 days to 74 months) were included. CTDIvol, DLP and ED were 0.90±0.24 mGy, 12.9±4.7 mGy∙cm and 0.64±0.21 mSv (range, 0.358–1.196 mSv), respectively. Image quality score was 4.3±0.5, and all images met the diagnostic requirements. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing CHD were 97.2%, 99.8%, 99.0%, and 99.5%, respectively, for MSCT, and 90.6%, 99.8%, 99.0%, and 98.4%, respectively, for TTE. MSCT not only had a higher sensitivity than TTE overall (97.2% vs. 90.6%; P<0.05), but was much more sensitive for the diagnosis of extracardiac vascular abnormalities (92.0% vs. 68.0%; P<0.05). Conclusion 128-slice low-dose prospective ECG-gated CT scanning has important clinical value in the diagnosis of complex CHD in children, complementing and extending the findings of TTE.
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Affiliation(s)
- Guilin Bu
- Radiology Department, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
- * E-mail:
| | - Ying Miao
- Radiology Department, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Jingwen Bin
- Radiology Department, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Sheng Deng
- Cardio-Thoracic Surgery, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Taowen Liu
- Science and Education Department, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Hongchun Jiang
- Radiology Department, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Weiping Chen
- Radiology Department, Nanxi Hill Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
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Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction. Pediatr Radiol 2016; 46:462-72. [PMID: 26739141 DOI: 10.1007/s00247-015-3510-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 09/27/2015] [Accepted: 11/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many technical updates have been made in multi-detector CT. OBJECTIVE To evaluate image quality and radiation dose of high-pitch second- and third-generation dual-source chest CT angiography and to assess the effects of different levels of advanced modeled iterative reconstruction (ADMIRE) in newborns and children. MATERIALS AND METHODS Chest CT angiography (70 kVp) was performed in 42 children (age 158 ± 267 days, range 1-1,194 days). We evaluated subjective and objective image quality, and radiation dose with filtered back projection (FBP) and different strength levels of ADMIRE. For comparison were 42 matched controls examined with a second-generation 128-slice dual-source CT-scanner (80 kVp). RESULTS ADMIRE demonstrated improved objective and subjective image quality (P < .01). Mean signal/noise, contrast/noise and subjective image quality were 11.9, 10.0 and 1.9, respectively, for the 80 kVp mode and 11.2, 10.0 and 1.9 for the 70 kVp mode. With ADMIRE, the corresponding values for the 70 kVp mode were 13.7, 12.1 and 1.4 at strength level 2 and 17.6, 15.6 and 1.2 at strength level 4. Mean CTDIvol, DLP and effective dose were significantly lower with the 70-kVp mode (0.31 mGy, 5.33 mGy*cm, 0.36 mSv) compared to the 80-kVp mode (0.46 mGy, 9.17 mGy*cm, 0.62 mSv; P < .01). CONCLUSION The third-generation dual-source CT at 70 kVp provided good objective and subjective image quality at lower radiation exposure. ADMIRE improved objective and subjective image quality.
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Diagnostic accuracy of sub-mSv prospective ECG-triggering cardiac CT in young infant with complex congenital heart disease. Int J Cardiovasc Imaging 2016; 32:991-8. [PMID: 26897005 DOI: 10.1007/s10554-016-0854-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
To explore the clinical value and evaluate the diagnostic accuracy of sub-mSv low-dose prospective ECG-triggering cardiac CT (CCT) in young infants with complex congenital heart disease (CHD). A total of 102 consecutive infant patients (53 boys and 49 girls with mean age of 2.9 ± 2.4 m and weight less than 5 kg) with complex CHD were prospectively enrolled. Scans were performed on a 64-slice high definition CT scanner with low dose prospective ECG-triggering mode and reconstructed with 80 % adaptive statistical iterative reconstruction algorithm. All studies were performed during free breathing with sedation. The subjective image quality was evaluated by 5-point grading scale and interobserver variability was calculated. The objective image noise (standard deviation, SD) and contrast to noise ratio (CNR) was calculated. The effective radiation dose from the prospective ECG-triggering mode was recorded and compared with the virtual conventional retrospective ECG-gating mode. The detection rate for the origin of coronary artery was calculated. All patients also underwent echocardiography before CCT examination. 81 patients had surgery and their preoperative CCT and echocardiography findings were compared with the surgical results and sensitivity, specificity, positive and negative predictive values and accuracy were calculated for separate cardiovascular anomalies. Heart rates were 70-161 beats per minute (bpm) with mean value of 129.19 ± 14.52 bpm. The effective dose of 0.53 ± 0.15 mSv in the prospective ECG-triggering cardiac CT was lower than the calculated value in a conventional retrospective ECG-gating mode (2.00 ± 0.35 mSv) (p < 0.001). The mean CNR and SD were 28.19 ± 13.00 and 15.75 ± 3.61HU, respectively. The image quality scores were 4.31 ± 0.36 and 4.29 ± 0.41 from reviewer 1 and 2 respectively with an excellent agreement between them (Kappa = 0.85). The detection rate for the origins of the left and right coronary arteries was 96 and 90 %, respectively. The detection rates of the origins of left coronary artery and right coronary artery in all cases were 96 % (78/81) and 90 % (73/81), respectively. Twenty cases of conotruncal anomalies and ALCAPA were validated surgically and the accuracy of cardiac CT diagnosis was 95 % (19/20). The overall deformity based sensitivity, specificity, positive predictive value and negative predictive value were 94.0.1, 99.9, 98.6, 99.5 % respectively, by CCT, and 88.2, 99.9, 97.8, 99.0 %, respectively, by echocardiography. Prospective ECG-triggering CCT with sub-mSv effective dose provides excellent imaging quality and high diagnostic accuracy for young infants with complex CHD.
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3D MDCT angiography for the preoperative assessment of truncus arteriosus. Clin Imaging 2015; 39:938-44. [DOI: 10.1016/j.clinimag.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/22/2022]
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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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Zhang JL, Liu BL, Zhao YM, Liang HW, Wang GK, Wan Y, Huang YH, Shen BZ. Combining Coronary with Carotid and Cerebrovascular Angiography Using Prospective ECG Gating and Iterative Reconstruction with 256-slice CT. Echocardiography 2014; 32:1291-8. [PMID: 25371093 DOI: 10.1111/echo.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin-Ling Zhang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Bai-Lu Liu
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Yan-Ming Zhao
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Hong-Wei Liang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Guo-Kun Wang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Yong Wan
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Ya-Hua Huang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Bao-Zhong Shen
- Department of Radiology; The Fourth Affiliated Hospital of Harbin Medical University; Key Laboratory of Molecular Imaging in College of Heilongjiang Province; Harbin China
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Accuracy, image quality, and radiation dose of prospectively ECG-triggered high-pitch dual-source CT angiography in infants and children with complex coarctation of the aorta. Acad Radiol 2014; 21:1248-54. [PMID: 25097011 DOI: 10.1016/j.acra.2014.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic accuracy, image quality, and radiation dose of prospective electrocardiogram (ECG)-triggered high-pitch dual-source computed tomography (DSCT) in infants and young children with complex coarctation of the aorta (CoA). MATERIALS AND METHODS Forty pediatric patients aged < 4 years with suspected CoA underwent prospective ECG-triggered high-pitch DSCT angiography and transthoracic echocardiography (TTE). Surgery and/or conventional cardiac angiography (CCA) were performed in all patients. The diagnostic accuracy of DSCT angiography and TTE was compared to the surgical and/or CCA findings. The causes of misdiagnosis and miss were analyzed, and the advantages and limitation of both imaging modalities were evaluated. Image quality of DSCT was evaluated, and effective radiation dose was calculated. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of DSCT in evaluation of complex CoA were 92.37%, 98.51%, 97.32%, 93.57%, and 96.25%, respectively. There was a significant difference in the accuracy between DSCT and TTE (χ² = 9.9, P<.05). For a total of 80 extracardiac anomalies, the sensitivity (98.8%, 79/80) of DSCT was greater than that of TTE (62.5%; 50 of 80). On the contrary, for 38 cardiac anomalies, the sensitivity (78.9%, 30 of 38) of DSCT was lesser than that of TTE (100%; 38 of 38). The mean score of image quality was 4.27 ± 0.73. The mean effective radiation dose was 0.20 ± 0.09 mSv. CONCLUSIONS Prospective ECG-triggered high-pitch DSCT may be a clinical feasible modality in the evaluation of pediatric patients with complex CoA, providing adequate image quality, high diagnostic accuracy, and low radiation dose.
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Sedaghat F, Pouraliakbar H, Motevalli M, Karimi MA, Armand S. Comparison of diagnostic accuracy of dual-source CT and conventional angiography in detecting congenital heart diseases. Pol J Radiol 2014; 79:164-8. [PMID: 24987488 PMCID: PMC4076227 DOI: 10.12659/pjr.890732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/07/2014] [Indexed: 11/09/2022] Open
Abstract
Background Cardiac dual-source computed tomography (DSCT) is primarily used for coronary arteries. There are limited studies about the application of DSCT for congenital heart diseases. The aim of this study was to determine the diagnostic value of DSCT in the cardiac anomalies. Material/Methods The images of DSCTs and conventional angiographies of 36 patients (21 male; mean age: 8.5 month) with congenital heart diseases were reviewed and the parameters of diagnostic value of these methods were compared. Cardiac surgery was the gold standard. Results A total of 105 cardiac anomalies were diagnosed at surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DSCT were 98.25%, 97.9%, 98.1%, 99.07%, and 98.2%, respectively. The corresponding values of angiography were 95.04%, 98.7%, 97.8%, 98.1%, and 98%, respectively. Only one atrial septal defect (ASD) and two patent ductus arteriosus (PDA) were missed by DSCT. Angiography missed two ASD and two PDA. DSCT also provided important additional findings (n=35) about the intrathoracic or intraabdominal organs. Conclusions DSCT is a highly accurate diagnostic modality for congenital heart diseases, obviating the need for invasive modalities. Beside its noninvasive nature, the advantage of DSCT over the angiography is its ability to provide detailed anatomical information about the heart, vessels, lungs and intraabdominal organs.
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Affiliation(s)
- Fariborz Sedaghat
- Department of Radiology and Cardiovascular Imaging, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Department of Radiology and Cardiovascular Imaging, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Motevalli
- Department of Radiology and Cardiovascular Imaging, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Karimi
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sandbad Armand
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ji X, Zhao B, Cheng Z, Si B, Wang Z, Duan Y, Nie P, Li H, Yang S, Jiao H, Wang X. Low-dose prospectively electrocardiogram-gated axial dual-source CT angiography in patients with pulsatile bilateral bidirectional Glenn Shunt: an alternative noninvasive method for postoperative morphological estimation. PLoS One 2014; 9:e94425. [PMID: 24736546 PMCID: PMC3988061 DOI: 10.1371/journal.pone.0094425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/16/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To explore the clinical value of low-dose prospectively electrocardiogram-gated axial dual-source CT angiography (low-dose PGA scanning, CTA) in patients with pulsatile bilateral bidirectional Glenn shunt (bBDG) as an alternative noninvasive method for postoperative morphological estimation. METHODS Twenty patients with pulsatile bBDG (mean age 4.2±1.6 years) underwent both low-dose PGA scanning and conventional cardiac angiography (CCA) for the morphological changes. The morphological evaluation included the anatomy of superior vena cava (SVC) and pulmonary artery (PA), the anastomotic location, thrombosis, aorto-pulmonary collateral circulation, pulmonary arteriovenous malformations, etc. Objective and subjective image quality was assessed. Bland-Altman analysis and linear regression analyses were used to evaluate the correlation on measurements between CTA and CCA. Effective radiation dose of both modalities was calculated. RESULTS The CT attenuation value of bilateral SVC and PA was higher than 300 HU. The average subjective image quality score was 4.05±0.69. The morphology of bilateral SVC and PA was displayed completely and intuitively by CTA images. There were 24 SVC above PA and 15 SVC beside PA. Thrombosis was found in 1 patient. Collateral vessels were detected in 13 patients. No pulmonary arteriovenous malformation was found in our study. A strong correlation (R2>0.8, P<0.001) was observed between the measurements on CTA images and on CCA images. Bland-Altman analysis demonstrated a systematic overestimation of the measurements by CTA (the mean value of bias>0).The mean effective dose of CTA and CCA was 0.50±0.17 mSv and 4.85±1.34 mSv respectively. CONCLUSION CT angiography with a low-dose PGA scanning is an accurate and reliable noninvasive examination in the assessment of morphological changes in patients with pulsatile bBDG.
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Affiliation(s)
- Xiaopeng Ji
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Zhaoping Cheng
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Biao Si
- Cardiovascular Institute of Jinan Military district, Jinan, People's Republic of China
| | - Zhiheng Wang
- Cardiovascular Institute of Jinan Military district, Jinan, People's Republic of China
| | - Yanhua Duan
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Pei Nie
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Haiou Li
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Shifeng Yang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Hui Jiao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
| | - Ximing Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China
- * E-mail:
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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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Jiao H, Xu Z, Wu L, Cheng Z, Ji X, Zhong H, Meng C. Detection of airway anomalies in pediatric patients with cardiovascular anomalies with low dose prospective ECG-gated dual-source CT. PLoS One 2013; 8:e82826. [PMID: 24324836 PMCID: PMC3855812 DOI: 10.1371/journal.pone.0082826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/29/2013] [Indexed: 12/03/2022] Open
Abstract
Objectives To assess the feasibility of low-dose prospective ECG-gated dual-source CT (DSCT) in detecting airway anomalies in pediatric patients with cardiovascular anomalies compared with flexible tracheobronchoscopy (FTB). Methods 33 pediatrics with respiratory symptoms who had been revealed cardiovascular anomalies by transthoracic echocardiography underwent FTB and contrast material–enhanced prospective ECG-triggering CT were enrolled. The study was approved by our institution review board and written informed consent was obtained from all patients’ guardian. DSCT examinations were performed to detect cardiovascular abnormalities using weight-adjusted low–dose protocol. Two radiologists independently performed CT image analysis. The FTB reports were reviewed by an experienced pulmonologist. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DSCT in the detection of airway anomalies were assessed. The tracheobronchial stenoses revealed on FTB were graded. Effective radiation dose was calculated. Results Thirty cases were diagnosed with tracheobronchial narrowing and/or abnormality in 33 patients by FTB, while 3 patients had normal FTB findings. Twenty-eight cases were diagnosed with airway anomalies by CT, of which 27 were correct positive. 3 patients with normal findings at CT had findings of tracheobronchial narrowing due to tracheobronchomalacia at inspiration at FTB. Sensitivity and specificity of CT were 90.0% (95% CI: 72.3%, 97.4%) and 66.7% (95% CI: 12.5 %, 98.2 %), respectively. PPV and NPV were 96.4% (95% CI: 79.8 %, 99.8%) and 40.0% (95% CI: 7.3%, 83.0%), respectively. Overall accuracy of DSCT in detecting airway anomalies in pediatrics with cardiovascular anomalies was 87.9% (95% CI: 74.5%, 97.6%). In grading of tracheobronchial stenosis, images from CT correlated closely (r = 0.89) with those of FTB. Mean effective dose was 0.60±0.20 mSv. Conclusion In pediatric patients, ECG-triggered CT to evaluate congenital cardiovascular anomalies can also be used to diagnose and characterize fixed airway involvement in relation to the vascular structures.
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Affiliation(s)
- Hui Jiao
- Shandong Medical Imaging Research Institute, Shandong University, Ji’nan, Shandong, People’s Republic of China
| | - Zhuodong Xu
- Shandong Medical Imaging Research Institute, Ji’nan, Shandong, People’s Republic of China
- * E-mail:
| | - Lebin Wu
- Shandong Medical Imaging Research Institute, Ji’nan, Shandong, People’s Republic of China
| | - Zhaoping Cheng
- Shandong Medical Imaging Research Institute, Ji’nan, Shandong, People’s Republic of China
| | - Xiaopeng Ji
- Shandong Medical Imaging Research Institute, Shandong University, Ji’nan, Shandong, People’s Republic of China
| | - Hai Zhong
- Department of Radiology, the Second Hospital of Shandong University, Ji’nan, Shandong, China
| | - Chen Meng
- Shandong University Qilu children hospital, Ji’nan, Shandong, China
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Glockler M, Halbfass J, Koch A, Dittrich S, Achenbach S, Ruffer A, Ihlenburg S, Cesnjevar R, May M, Uder M, Rompel O. Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases. Eur J Cardiothorac Surg 2013; 45:1060-5. [DOI: 10.1093/ejcts/ezt537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Yu FF, Lu B, Gao Y, Hou ZH, Schoepf UJ, Spearman JV, Cao HL, Sun ML, Jiang SL. Congenital anomalies of coronary arteries in complex congenital heart disease: diagnosis and analysis with dual-source CT. J Cardiovasc Comput Tomogr 2013; 7:383-90. [PMID: 24331934 DOI: 10.1016/j.jcct.2013.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/18/2013] [Accepted: 11/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Congenital heart diseases (CHDs) are sometimes associated with coronary artery anomalies (CAAs). Accurate preoperative evaluation of coronary artery anatomy is essential for successful surgical repair of complex CHD. OBJECTIVE The aim of this study was to evaluate the incidence of congenital CAAs in patients with complex CHD at dual-source CT. METHODS Four hundred seventeen consecutive patients with complex CHD underwent contrast-enhanced cardiac CT angiography. The results were retrospectively analyzed, including the types and incidences of CAAs in various forms of complex CHD. Each patient was analyzed independently by 2 experienced cardiovascular radiologists. Image quality of coronary arteries was assessed on a 5-point scale with 2 or less being nondiagnostic. RESULTS Thirty-five of 417 studies were nondiagnostic (8.39%). Sixty-three cases of CAA (15.11%) were detected by anomalous ostia and coronary arteries. CAA was involved in 6 of 108 patients with tetralogy of Fallot (5.56%), 18 of 84 patients with double outlet right ventricle (21.43%), 11 of 97 patients with pulmonary artery atresia (11.34%), 7 of 36 patients with transposition of the great arteries (22.22%), 15 of 41 patients with single ventricle (36.59%), 4 of 12 patients with truncus arteriosus/aortopulmonary window (33.33%), and 2 of 39 patients with interruption of the aortic arch/coarctation of the aorta (5.13%). Twenty of these were accompanied with an anomalous coronary course (31.74%). CONCLUSION Patients with complex CHD have a higher prevalence of CAAs, which should be considered before surgery. Dual-source CT is an effective technique to visualize and evaluate complex CHD.
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Affiliation(s)
- Fang-fang Yu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bin Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Yang Gao
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhi-hui Hou
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - James V Spearman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Hui-li Cao
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ming-li Sun
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shi-liang Jiang
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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