Patient-related factors influencing detectability of coronary arteries in 320-row CT angiography in infants with complex congenital heart disease

Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children

INTRODUCTION

Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children.

MATERIALS

Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability.

RESULTS

Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval.

CONCLUSIONS

Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient's body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.

The Value of Iterative Reconstruction of Algorithm-Based Coronary Artery Computed Tomography Imaging in the Diagnosis of Old Myocardial Infarction

The objective of this study was to compare the diagnostic value of computed tomography (CT) based on iterative reconstruction algorithm in old myocardial infarction (OMI), thereby providing theoretical guidance and practical basis for clinical treatment. In this study, in order to provide theoretical guidance and practical basis for the diagnosis and treatment of clinical OMI, 10 patients with OMI were selected and divided into two groups, with 5 patients in each group. In addition, an algebraic iterative reconstruction algorithm is constructed, which starts from the initial estimation value, compares, and corrects the estimation results and the measured results continuously until the error between the two results is less than the predetermined value. The experimental group was optimized by algebraic iterative reconstruction algorithm, and the control group was reconstructed by the hospital original method. The image quality parameters under different iteration times were analyzed and compared to obtain the optimal iteration times. The value of iterative reconstruction algorithm in clinical diagnosis was investigated by analyzing the time of drawing and the accuracy of diagnosis after drawing. Through the analysis and comparison of the image quality parameters of the patients from the experimental group, it was found that the image quality firstly increased with the increase in the number of iterations but decreased with the increase of the number of iterations after a certain number of iterations. The results showed that the optimal number of iterations was 13 times. The drawing time of the experimental group and the control group was 54.27 minutes and 117.87 minutes in turn, so the difference between the two groups was significant (P < 0.05). Besides, there was a statistically marked difference in the accuracy rate of the experimental group (93.33%) and the control group (73.33%) (P < 0.05). In conclusion, the time required for coronary artery CT imaging using algebraic iterative reconstruction algorithm was greatly reduced and the diagnostic accuracy was hugely improved. Therefore, the coronary artery CT imaging based on iterative reconstruction algorithm could make more effective use of medical resources and improve the diagnostic accuracy in the diagnosis of OMI.

Quantitative evaluation of coronary artery visibility on CT angiography in Kawasaki disease: young vs. old children

Coronary artery visibility on coronary CT angiography has rarely been investigated in young children with Kawasaki disease. This retrospective study was performed to quantitatively evaluate and compare coronary artery visibility with sufficient quality to measure it on coronary CT angiography among younger and older children with Kawasaki disease. Seventy-eight consecutive children with Kawasaki disease who underwent coronary CT angiography were divided into two groups: group 1 (age ≤ 6 years; n = 37) and group 2 (age > 6 years and < 18 years; n = 41). The visibility of the right coronary artery, left anterior descending artery, and left circumflex artery was quantitatively evaluated by dividing the length of the assessable coronary artery by the length of the corresponding groove, and compared between the two groups. The coronary artery visibility in group 1 was significantly lower than that in group 2 for the right coronary artery (77.8 ± 26.3% vs. 94.2 ± 13.6%, p < 0.002) and left anterior descending artery (54.8 ± 19.5% vs. 69.6 ± 21.3%, p < 0.003, but the difference was not significant for the left circumflex artery (43.7 ± 23.1% vs. 43.9 ± 26.7%, p > 0.9). In both groups, the visibility of the right coronary artery was the highest, followed by those of the left anterior descending artery and left circumflex artery. Compared with older children with Kawasaki disease, younger children with Kawasaki disease demonstrate significantly lower visibility of the right coronary artery and left anterior descending artery on coronary CT angiography. In contrast, the visibility of the left circumflex artery showed no significant difference between younger and older children with Kawasaki disease.