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Bernheim S, Borgel A, Le Garrec JF, Perthame E, Desgrange A, Michel C, Guillemot L, Sart S, Baroud CN, Krezel W, Raimondi F, Bonnet D, Zaffran S, Houyel L, Meilhac SM. Identification of Greb1l as a genetic determinant of crisscross heart in mice showing torsion of the heart tube by shortage of progenitor cells. Dev Cell 2023; 58:2217-2234.e8. [PMID: 37852253 DOI: 10.1016/j.devcel.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/28/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
Despite their burden, most congenital defects remain poorly understood, due to lack of knowledge of embryological mechanisms. Here, we identify Greb1l mutants as a mouse model of crisscross heart. Based on 3D quantifications of shape changes, we demonstrate that torsion of the atrioventricular canal occurs together with supero-inferior ventricles at E10.5, after heart looping. Mutants phenocopy partial deficiency in retinoic acid signaling, which reflect overlapping pathways in cardiac precursors. Spatiotemporal gene mapping and cross-correlated transcriptomic analyses further reveal the role of Greb1l in maintaining a pool of dorsal pericardial wall precursor cells during heart tube elongation, likely by controlling ribosome biogenesis and cell differentiation. Consequently, we observe growth arrest and malposition of the outflow tract, which are predictive of abnormal tube remodeling in mutants. Our work on a rare cardiac malformation opens novel perspectives on the origin of a broader spectrum of congenital defects associated with GREB1L in humans.
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Affiliation(s)
- Ségolène Bernheim
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France
| | - Adrien Borgel
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France
| | - Jean-François Le Garrec
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France
| | - Emeline Perthame
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France; Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics Hub, 75015 Paris, France
| | - Audrey Desgrange
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France
| | - Cindy Michel
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France
| | - Laurent Guillemot
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France
| | - Sébastien Sart
- Institut Pasteur, Université Paris Cité, Physical Microfluidics and Bio-Engineering, Department of Genomes and Genetics, 75015 Paris, France
| | - Charles N Baroud
- Institut Pasteur, Université Paris Cité, Physical Microfluidics and Bio-Engineering, Department of Genomes and Genetics, 75015 Paris, France; Laboratoire d'Hydrodynamique, CNRS, École polytechnique, Institut Polytechnique de Paris, 91120 Palaiseau, France
| | - Wojciech Krezel
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut de la Santé et de la Recherche Médicale (U1258), Centre National de la Recherche Scientifique (UMR7104), Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, 67404 Illkirch, France
| | - Francesca Raimondi
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, APHP, Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France; M3C-Necker, Hôpital universitaire Necker-Enfants Malades, APHP, Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital universitaire Necker-Enfants Malades, APHP, Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | | | - Lucile Houyel
- M3C-Necker, Hôpital universitaire Necker-Enfants Malades, APHP, Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Sigolène M Meilhac
- Université Paris Cité, Imagine-Institut Pasteur, Unit of Heart Morphogenesis, INSERM UMR1163, 75015 Paris, France.
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Aboul Hamad MS, Attalla EM, Amer HH, Fathy MM. Assessment of diagnostic reference levels for paediatric cardiac computed tomography in accordance with European guidelines. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023:10.1007/s00411-023-01031-6. [PMID: 37349577 DOI: 10.1007/s00411-023-01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 06/24/2023]
Abstract
Recently, paediatric cardiac computed tomography (CCT) has caused concerns that diagnostic image quality and dose reduction may require further improvement. Consequently, this study aimed to establish institutional (local) diagnostic reference levels (LDRLs) for CCT for paediatric patients, and assess the impact of tube voltage on proposed DRLs in terms of the volume computed tomography index (CTDIvol) and dose length product (DLP). In addition, effective doses (EDs) of exposure were estimated. A population of 453 infants, whose mass and age were less than 12 kg and 2 years, respectively, were considered from January 2018 to August 2021. Based on previous studies, this number of patients was considered to be sufficient for establishing LDRLs. A group of 245 patients underwent CCT examinations at 70 kVp tube voltage with an average scan range of 23.4 cm. Another set of 208 patients underwent CCT examinations at 100 kVp tube voltage with an average scan range of 15.8 cm. The observed CTDIvol and DLP values were 2.8 mGy and 54.8 mGy.cm, respectively. The mean effective dose (ED) was 1.2 mSv. It is concluded that provisional establishment and use of DRLs for cardiac computed tomography in children are crucial, and further research is needed to develop regional and international DRLs.
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Affiliation(s)
- Mohamed S Aboul Hamad
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt.
- Radiology Department, ALNas Hospital, Cairo, Egypt.
| | - Ehab M Attalla
- National Cancer Institute, Cairo University, Giza, Egypt
| | - Hanan H Amer
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Mohamed M Fathy
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
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Clinical Question Influence on Radiation Dose of Cardiac CT Scan in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081172. [PMID: 36010062 PMCID: PMC9406619 DOI: 10.3390/children9081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
Background: To assess the impact of different clinical questions on radiation doses acquired during cardiac computed tomography in children. Methods: A total of 116 children who underwent cardiac CT on a third-generation dual-source CT scanner were included. The clinical questions were divided into three main categories: the extent of scanning in the z-axis, coronary artery assessment and cardiac function assessment. Radiation dose values represented as a dose-length product (DLP) in mGy*cm were recorded from the CT scanner protocols. Results: There were significantly higher doses in cases with cardiac function assessment (median DLP 348 versus 59 mGy*cm, p < 0.01) and in cases with coronary artery assessment (median DLP 133 versus 71 mGy*cm, p < 0.01). Conclusion: The most important factor was the assessment of cardiac function, where the median radiation dose was 4.3× higher in patients with a request for cardiac function assessment. We strongly recommend that clinical requests for cardiac CT should be carefully considered in the paediatric population.
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Aeschlimann FA, Raimondi F, Leiner T, Aquaro GD, Saadoun D, Grotenhuis HB. Overview of imaging in adult- and childhood-onset Takayasu arteritis. J Rheumatol 2021; 49:346-357. [PMID: 34853087 DOI: 10.3899/jrheum.210368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
Takayasu Arteritis is an idiopathic large vessel vasculitis, that affects young adults and children and can lead to ischemia and end-organ damage. Vascular imaging is crucial for diagnosis, assessment of disease extent and management of the disease. In this article, we critically review evidence for the clinical use of the different imaging modalities conventional angiography, magnetic resonance imaging, computed tomography, Doppler ultrasound and 18fluorodeoxyglucose positron emission tomography. We thereby focus on their clinical applicability, challenges and specific use in children.
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Affiliation(s)
- Florence A Aeschlimann
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Francesca Raimondi
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Tim Leiner
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Giovanni Donato Aquaro
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - David Saadoun
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Heynric B Grotenhuis
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
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Browne JE, Bruesewitz MR, Thomas V, Thomas KB, Hull NC, McCollough CH, Yu L. Procedure for optimal implementation of automatic tube potential selection in pediatric CT to reduce radiation dose and improve workflow. J Appl Clin Med Phys 2020; 22:194-202. [PMID: 33338314 PMCID: PMC7882104 DOI: 10.1002/acm2.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
It is important to employ radiation dose reduction techniques in pediatric computed tomography (CT) to reduce potential risks of radiation‐induced malignancy. Automatic tube potential (kV) selection tools have been developed and become available on many CT scanners, which select the optimum kV based on the patient size and clinical task to improve the radiation dose efficiency. However, its use in pediatric CT has been mostly empirical, following manufacturer’s default recommendation without solid demonstration for quality improvement. This study aimed to implement an automatic tube potential tool (CAREkV, Siemens Healthcare) into routine pediatric CT practice, using the “Plan‐Do‐Study‐Act” quality improvement process, in place of an existing kV/mAs technique chart. The design of this quality improvement project involved Plan‐Do‐Study‐Act stages. Plan and Do stages identified the criteria for optimal automatic kV selection; a range of phantoms representing typical pediatric groups were scanned on a dual‐source 128‐slice scanner using a fast‐pitch scanning mode. The identified CAREkV settings were implemented into the CT protocol and evaluated after a 6‐month period. In the Study stage, an objective evaluation of the image metrics and radiation dose for two similar patient cohorts using CAREkV and the technique‐chart, respectively, were compared. The kV selected, image quality and radiation dose determined by CAREkV were comparable to those obtained while using the technique‐chart. The CAREkV was successfully implemented into our pediatric abdominopelvic CT practice. By utilizing the “PDSA” process optimal image quality and radiation dose reduction were achieved with an automatic kV selection tool to improve CT workflow.
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Affiliation(s)
| | | | - Vrieze Thomas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Warin Fresse K, Isorni MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Cardiac computed tomography angiography in the paediatric population: Expert consensus from the Filiale de cardiologie pédiatrique et congénitale (FCPC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV). Arch Cardiovasc Dis 2020; 113:579-586. [PMID: 32522436 DOI: 10.1016/j.acvd.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
This paper aims to provide a paediatric cardiac computed tomography angiography expert panel consensus based on the opinions of experts from the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) and the Filiale de cardiologie pédiatrique congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, computed tomography angiography radiation dose reduction techniques and postprocessing techniques. We think that to realize its full potential and to avoid pitfalls, cardiac computed tomography angiography in children with congenital heart disease requires training and experience. Moreover, paediatric cardiac computed tomography angiography protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible, to prevent unnecessary radiation exposure. We also provide a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
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Affiliation(s)
- Karine Warin Fresse
- Imagerie cardiovasculaire fédération des cardiopathies congénitales, CHU de Nantes HGRL, 44093 Nantes, France
| | - Marc Antoine Isorni
- Unité de radiologie diagnostique et thérapeutique, hôpital Marie-Lannelongue, 92350 Le Plessis Robinson, France
| | - Jean Nicolas Dacher
- Cardiac MR/CT Unit, University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, 76183 Rouen, France
| | - François Pontana
- Inserm UMR 1011, Department of Cardiovascular Radiology, EGID (European Genomic Institute for Diabetes), université de Lille, Institut Cœur-Poumon, Institut Pasteur de Lille, CHU de Lille, FR3508, 59000 Lille, France
| | - Guillaume Gorincour
- Image(2), institut méditerranéen d'imagerie médicale appliquée à la gynecologie, grossesse et enfance, 13008 Marseille, France
| | - Nathalie Boddaert
- Paediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, 75743 Paris, France
| | - Alexis Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU La Timone, Marseille, France
| | - Francesca Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes (M3C), hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
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7
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Assessment of imaging protocol and patient radiation exposure in pediatric computed tomography angiography. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Warin-Fresse K, Isornii MA, Dacher JN, Pontana F, Gorincour G, Boddaert N, Jacquier A, Raimondi F. Pediatric cardiac computed tomography angiography: Expert consensus from the Filiale de Cardiologie Pédiatrique et Congénitale (FCPC) and the Société Française d'Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV). Diagn Interv Imaging 2020; 101:335-345. [PMID: 32029386 DOI: 10.1016/j.diii.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
This article was designed to provide a pediatric cardiac computed tomography angiography (CCTA) expert panel consensus based on opinions of experts of the Société Française d'Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV) and of the Filiale de Cardiologie Pédiatrique Congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, CTA radiation dose reduction techniques, and post-processing techniques. The consensus was based on data from available literature (original papers, reviews and guidelines) and on opinions of a group of specialists with extensive experience in the use of CT imaging in congenital heart disease. In order to reach high potential and avoid pitfalls, CCTA in children with congenital heart disease requires training and experience. Moreover, pediatric cardiac CCTA protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible to prevent unnecessary radiation exposure. We also provided a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.
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Affiliation(s)
- K Warin-Fresse
- Department of Cardiovascular Imaging, CHU Nantes HGRL, 44093 Nantes, France
| | - M-A Isornii
- Department of Radiology, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
| | - J-N Dacher
- Department of Radiology, Rouen University Hospital, 76031 Rouen, France; Inserm U1096, UFR Médecine-Pharmacie, University of Rouen, 76000 Rouen, France
| | - F Pontana
- Department of Cardiovascular Radiology, Institut Cœur-Poumon, CHU Lille, INSERM UMR 1011, Institut Pasteur de Lille, EGID, FR3508, Univ Lille, 59000 Lille, France
| | - G Gorincour
- Image2, Mediterranean Institute of Medical Imaging, 13008 Marseille, France
| | - N Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - A Jacquier
- Department of Radiology, University of Marseille Méditerranée, CHU la Timone, 13000 Marseille, France
| | - F Raimondi
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France.
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Hsiao CC, Chen PC, Kuo PC, Ho CH, Jao JC. Assessment of image quality and dose in contrast-enhanced head and neck CT angiography of New Zealand rabbit. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:739-750. [PMID: 32597826 DOI: 10.3233/xst-200669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although computed tomography (CT) is a powerful diagnostic imaging modality for diagnosing vascular diseases, it is some what risky to human health due to the high radiation dosage. Thus, CT vendors have developed low dose computed tomography (LDCT) aiming to solve this problem. Nowadays, LDCT has gradually become a main stream of CT examination. OBJECTIVE This study aimed to assess the feasibility of LDCTAin an animal model and compare the imaging features and doses in two clinical scanners. METHODS Twenty-two New Zealand rabbit head and neck CTA images pre- and post-contrast agent injection were performed using256-sliceand 64-slice CT scanners. The tube voltages used in the 256-slice and the 64-slice CTA were 70 kVp and 80 kVp, respectively. Quantitative images indices and radiation doses obtained from CTA in these two scanners were compared. RESULTS More neck arterial vessels could be visualized in multi-planar reconstruction (MPR) CTA on the 256-slice CT scanner than on the 64-slice CT scanner. After contrast agent injection, all observed neck arterial vessels had higher CT numbers in 256-slice CTA than in 64-slice CTA. There was no significant difference in contrast-to-noise (CNR) of CTA images between these two scanners. CT dose index (CTDI) and dose length product (DLP) for the 256-slice CTA were lower than those for the 64-slice CTA. CONCLUSIONS Low dose CTA of rabbits with 70 or 80 kVp is feasible in a 256-slice or a 64-slice CT scanner. The radiation dose from the 256-slice CTA was much lower than that from the 64-slice CTA with comparable SNR and CNR. The technique can be further applied in longitudinal monitoring of an animal stroke model in the future.
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Affiliation(s)
- Chia-Chi Hsiao
- Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan, R.O.C
| | - Po-Chou Chen
- Department of Biomedical Engineering, I-Shou University, Taiwan, R.O.C
| | - Pei-Chi Kuo
- Department of Biomedical Engineering, I-Shou University, Taiwan, R.O.C
| | - Chih-Hao Ho
- Department of Medical Imaging, Taipei City Hospital (Yangming Branch), Taiwan, R.O.C
| | - Jo-Chi Jao
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Taiwan, R.O.C
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Le Roy J, Zarqane H, Azais B, Vernhet Kovacsik H, Mura T, Okerlund D, Lacampagne A, Amedro P. Impact of Motion Correction Algorithms on Image Quality in Children Undergoing Coronary Computed Tomography Angiography: A Comparison With Regular Monophasic and Multiphasic Acquisitions. Circ Cardiovasc Imaging 2019; 12:e009650. [PMID: 31766863 DOI: 10.1161/circimaging.119.009650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julien Le Roy
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., P.A.).,PhyMedExp (J.L.R., A.L., P.A.), University of Montpellier, CNRS, INSERM, CHU Montpellier, France
| | - Hamid Zarqane
- Radiology Department, CHU Montpellier, France (H.Z., B.A., H.V.K.)
| | - Benoit Azais
- Radiology Department, CHU Montpellier, France (H.Z., B.A., H.V.K.)
| | | | - Thibault Mura
- Epidemiology and Clinical Research Department (T.M.), University of Montpellier, CNRS, INSERM, CHU Montpellier, France
| | | | - Alain Lacampagne
- PhyMedExp (J.L.R., A.L., P.A.), University of Montpellier, CNRS, INSERM, CHU Montpellier, France
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., P.A.).,PhyMedExp (J.L.R., A.L., P.A.), University of Montpellier, CNRS, INSERM, CHU Montpellier, France
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11
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Pushparajah K, Duong P, Mathur S, Babu-Narayan SV. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Cardiovascular MRI and CT in congenital heart disease. Echo Res Pract 2019; 6:ERP-19-0048. [PMID: 31730044 PMCID: PMC6893312 DOI: 10.1530/erp-19-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular MRI and CT are useful imaging modalities complimentary to echocardiography. This review article describes the common indications and consideration for the use of MRI and CT in the management of congenital heart disease.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | | | - Sonya V Babu-Narayan
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
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12
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Le Roy J, Vernhet Kovacsik H, Zarqane H, Vincenti M, Abassi H, Lavastre K, Mura T, Lacampagne A, Amedro P. Submillisievert Multiphasic Coronary Computed Tomography Angiography for Pediatric Patients With Congenital Heart Diseases. Circ Cardiovasc Imaging 2019; 12:e008348. [PMID: 30704282 DOI: 10.1161/circimaging.118.008348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of coronary computed tomography (CT) angiography in children with coronary artery anomalies is increasing. However, it remains technically demanding and the need to adapt acquisition parameters to a patient's cardiac characteristics has not yet been addressed. The aim of the study was to prospectively assess the feasibility of personalized multiphasic coronary CT angiography for pediatric patients. METHODS Fifty pediatric patients (mean age 6.1±4.9 years) with coronary artery anomalies underwent a coronary CT angiography on a wide detector single-source CT equipment. Fifteen different acquisition patterns were used to trigger the acquisition at the best theoretical moment within the cardiac cycle. The appropriate pattern was automatically selected based on the patient's heart rate and heart rate variability, derived from the patient's ECG. Two independent radiologists qualitatively evaluated images. RESULTS All acquisitions fully answered the clinical question for a mean effective dose of 0.97±0.34 mSv. Image quality qualified as good or excellent in 94% of cases (47/50). No examination was considered as not assessable but 6% (3/50) were scored as adequate for diagnosis. For these 3 patients, motion artifacts were the main cause of average image quality. No significant visual differences were reported between the different coronary arteries (mean score of 3.6 on a 4-point scale). No correlation between image quality and cardiac parameters were reported ( r=-0.19 and r=0.00, respectively for heart rate and heart rate variability). CONCLUSIONS Personalized multiphasic coronary CT angiography acquisitions could be performed with diagnostic quality for a dose equivalent of <4 months of natural background irradiation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT03194763.
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Affiliation(s)
- Julien Le Roy
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., M.V., H.A., K.L., P.A.).,PHYMEDEXP, University of Montpellier, CNRS, INSERM, CHU Montpellier, France (J.L.R., M.V., A.L., P.A.)
| | | | - Hamid Zarqane
- Radiology Department, CHU Montpellier, France (H.V.K., H.Z.)
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., M.V., H.A., K.L., P.A.).,PHYMEDEXP, University of Montpellier, CNRS, INSERM, CHU Montpellier, France (J.L.R., M.V., A.L., P.A.)
| | - Hamouda Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., M.V., H.A., K.L., P.A.)
| | - Kathleen Lavastre
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., M.V., H.A., K.L., P.A.)
| | - Thibault Mura
- Epidemiology and Clinical Research Department, University of Montpellier, INSERM, CHU Montpellier, France (T.M.)
| | - Alain Lacampagne
- PHYMEDEXP, University of Montpellier, CNRS, INSERM, CHU Montpellier, France (J.L.R., M.V., A.L., P.A.)
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., M.V., H.A., K.L., P.A.).,PHYMEDEXP, University of Montpellier, CNRS, INSERM, CHU Montpellier, France (J.L.R., M.V., A.L., P.A.)
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13
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Low-dose paediatric cardiac and thoracic computed tomography with prospective triggering: Is it possible at any heart rate? Phys Med 2018; 49:99-104. [PMID: 29866350 DOI: 10.1016/j.ejmp.2018.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To demonstrate that the use of step-and-shoot (SAS) mode in paediatric cardiac CT angiography (CCTA) is possible at heart rates (HR) greater than 65 bpm, allowing low-dose acquisition with single-source 64-slices CT. METHODS We retrospectively included 125 paediatric patients (0-6 years). CCTA was performed with SAS at diastolic phase in 31 patients (group D, HR < 65 bpm), at systolic phase in 45 patients (group S, HR ≥ 65 bpm) and with non-gated mode in 49 patients (group NG). Effective dose (ED) and image quality using a 3-grade scoring scale (1, excellent; 2, moderate; 3, insufficient) of group S were compared with group D for coronary examinations and group NG for entire thorax vascular anatomy. RESULTS For coronary indications, median ED was 0.6 mSv in group D versus 0.9 mSv in group S (p < 0.01). For whole thorax indications, median ED was 2.7 mSv in group NG versus 1.1 mSv in group S (p < 0.001). The mean image quality score was (1.4 ± 0.6) points in group D, (1.4 ± 0.7) in group S for coronary indications (p = 0.9), (1.3 ± 0.6) in group S for whole thorax indications and (2.0 ± 0.0) in group NG (p < 0.001). CONCLUSION SAS mode is feasible in children with HR greater than 65 bpm allowing low-dose CCTA. It provided comparable image quality in systole, compared to diastole. SAS at the systolic phase provided better image quality with less radiation dose compared to non-gated scans for whole thorax examinations.
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Optimization of Scan and Reconstruction Parameters for Renal Artery CT Angiography with Iterative Reconstruction at Low kVp Compared with Filtered Back Projection at 120 kVp Acquisition. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.14860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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den Harder AM, Suchá D, van Doormaal PJ, Budde RPJ, de Jong PA, Schilham AMR, Breur JMPJ, Leiner T. Radiation dose reduction in pediatric great vessel stent computed tomography using iterative reconstruction: A phantom study. PLoS One 2017; 12:e0175714. [PMID: 28410386 PMCID: PMC5391930 DOI: 10.1371/journal.pone.0175714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/30/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To study dose reduction using iterative reconstruction (IR) for pediatric great vessel stent computed tomography (CT). METHODS Five different great vessel stents were separately placed in a gel-containing plastic holder within an anthropomorphic chest phantom. The stent lumen was filled with diluted contrast gel. CT acquisitions were performed at routine dose, 52% and 81% reduced dose and reconstructed with filtered back projection (FBP) and IR. Objective image quality in terms of noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) as well as subjective image quality were evaluated. RESULTS Noise, SNR and CNR were improved with IR at routine and 52% reduced dose, compared to FBP at routine dose. The lowest dose level resulted in decreased objective image quality with both FBP and IR. Subjective image quality was excellent at all dose levels. CONCLUSION IR resulted in improved objective image quality at routine dose and 52% reduced dose, while objective image quality deteriorated at 81% reduced dose. Subjective image quality was not affected by dose reduction.
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Affiliation(s)
- Annemarie M. den Harder
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - Dominika Suchá
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | | | - Pim A. de Jong
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Arnold M. R. Schilham
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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