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Gould SW, Harty MP, Cartoski M, Krishnan V, Givler N, Ostrowski J, Tsuda T. Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children. Cardiol Young 2024; 34:838-845. [PMID: 37877254 DOI: 10.1017/s1047951123003438] [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] [Indexed: 10/26/2023]
Abstract
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.
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Affiliation(s)
- Sharon W Gould
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - M Patricia Harty
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Vijay Krishnan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Nicole Givler
- Radiology Department, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - John Ostrowski
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
| | - Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health Delaware Valley, Wilmington, DE, USA
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Goo HW. Diagnostic imaging for absent pulmonary valve syndrome: an update with an emphasis on cardiothoracic computed tomography. Pediatr Radiol 2022; 52:1167-1174. [PMID: 35039934 DOI: 10.1007/s00247-021-05254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Absent pulmonary valve syndrome is a rare congenital heart disease characterized by partial or complete absence of pulmonary valve cusps which commonly presents with respiratory difficulty during infancy. Because central airway compression by dilated central pulmonary arteries is a key pathology of this syndrome responsible for clinical presentation, severity, and outcome, cardiothoracic computed tomography (CT) is currently regarded as the imaging modality of choice before and after treatment. In addition, tracheobronchomalacia frequently responsible for persistent respiratory problems can be accurately evaluated with conventional two-dimensional cine CT or four-dimensional CT. In this pictorial review, various diagnostic imaging methods used to evaluate absent pulmonary valve syndrome are comprehensively illustrated with an emphasis on a recently spotlighted role of cardiothoracic CT.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Malone LJ, Morin CE, Browne LP. Coronary computed tomography angiography in children. Pediatr Radiol 2022; 52:2498-2509. [PMID: 34734316 PMCID: PMC8566193 DOI: 10.1007/s00247-021-05209-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022]
Abstract
Imaging the coronary arteries of children, with their faster heart rates, small vessel size and common inability to lie still or breath-hold, has been a major challenge. With numerous advances in technology, CT examinations can now be performed quickly, often with children free-breathing and with much lower radiation doses than previously. This has led to increased use in children. Care must be taken with technique and choice of electrocardiogram (ECG)-gating technique to obtain adequate imaging for a diagnosis while keeping radiation dose as low as reasonably achievable (ALARA). In this paper, we discuss techniques and tips for CT imaging of the coronary arteries in children, including use of dual-source- and ultrawide-detector CT scanners.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, University of Colorado, Aurora, CO, USA.
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA.
| | - Cara E Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado, Aurora, CO, USA
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA
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Wang B, Huang LT, Hsieh ML, Wang CK, Wang JN, Kan CD, Wu JM, Tsai YS. Diastolic and systolic right ventricular diameters for predicting pulmonary hypertension in children with congenital heart disease. Clin Imaging 2020; 70:67-73. [PMID: 33125987 DOI: 10.1016/j.clinimag.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
Prospective electrocardiography (ECG)-gated cardiac computed tomography angiography (CTA) is widely used for pediatric patients with congenital heart disease (CHD) due to the lower radiation dose compared with the ECG-gated technique. However, functional parameters acquired using ECG-gated cardiac CT to predict pulmonary hypertension (PH) in children with CHD have not yet been reported. This study aimed to investigate the potential of diastolic and systolic right ventricular diameters (RVD) on prospective ECG-gated cardiac CTA to predict PH in children with CHD. A total of 44 children with CHD were divided into two groups: CHD with PH (n = 22) and CHD without PH (n = 22). The association between ECG-gated CTA parameters and PH was evaluated by logistic regression. The receiver operating characteristic curve (ROC) was used to find the best cut-off point for the parameters measured by Youden's index. Patients with higher RVD-BSA [aOR (95% CI) diastolic: 2.76 (1.23-6.23); systolic: 6.15 (1.72-22.06)] had higher risk of PH after adjusting for age and patent ductus arteriosus. The area under the curve (AUC) of D-RVD-BSA was 0.907 and the AUC of S-RVD-BSA was 0.917. Logistic regression showed that patients with D-RVD-BSA over 6.86 or S-RVD-BSA over 5.87 had significantly higher risk of PH after adjustments (aOR = 23.52, 95% CI = 2.89-191.03; aOR = 31.14, 95% CI = 2.75-352.85). In conclusion, in children with CHD, measurements of diastolic or systolic BSA-modified RVDs on prospective ECG-gated CTA are non-invasive markers of PH. BSA-modified D-RVD of 6.86 or BSA-modified S-RVD of 5.87 may be used to identify PH in children with CHD.
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Affiliation(s)
- Bow Wang
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ting Huang
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Min-Ling Hsieh
- Departments of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Kuo Wang
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jieh-Neng Wang
- Departments of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Dann Kan
- Department of Surgery and Institute of Cardiovascular Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Ming Wu
- Departments of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Shan Tsai
- Departments of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Malone LJ, Olson A, Barker AJ, Mong DA, Weinman JP, Browne LP. Visualization of proximal coronary arteries on high-pitch electrocardiogram-triggered computed tomography in pediatric congenital heart disease: effects of heart rate and body surface area. Pediatr Radiol 2020; 50:1375-1380. [PMID: 32696109 DOI: 10.1007/s00247-020-04730-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND As CT technology has advanced, techniques for pediatric cardiac CT in congenital heart disease have evolved from retrospective electrocardiography (ECG)-gating with relatively high radiation doses to lower-dose prospective ECG-gating and even single-beat gated scans. Despite these advances, coronary artery imaging in children remains challenging because of their small vessel size and high heart rates, often necessitating retrospective gating. OBJECTIVE Evaluate coronary artery visualization in pediatric patients (<20 years) who underwent low-dose high-pitch ECG-triggered scans and stratify the probability of coronary artery visualization based upon heart rate and body surface area (BSA). MATERIALS AND METHODS Two hundred eleven high-pitch ECG-triggered studies from April 2014 to November 2017 were reviewed by two pediatric cardiac imagers in this retrospective study. Patient age, gender, BSA, average heart rate, heart rate variability and use of general anesthesia were recorded as well as dose-length product (DLP) and volumetric CT dose index (CTDIvol). We assessed the coronary artery score using a 5-point scale, with score of ≥3 considered of diagnostic quality. We performed multivariate statistical analysis including logistic regression to analyze effects of heart rate and BSA. RESULTS Patient age range was 1 day to 19 years (median age 3 years). Heart rate range was 49-188 beats per minute (bpm; median 122 bpm) and BSA range was 0.15-2.07 m2 (median 0.53 m2). The origin and proximal coronary arteries were confidently seen (score ≥3) in 61% of studies in this cohort. Coronary artery visualization scores further increased with increased BSA (P<0.002) and with decreased heart rate (P<0.001). At heart rates <100 bpm or in patients with BSA>0.58, adequate coronary artery visualization was present 72% of the time. CONCLUSION While in many patients the coronary artery origins are visualized using high-pitch ECG-triggered technique, the importance of coronary artery visualization needs to be weighed with the radiation dose penalty in individual patients to achieve optimal imaging.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Ave., L954, Aurora, CO, 80045, USA. .,Children's Hospital of Colorado, Aurora, CO, USA.
| | - Andrew Olson
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Ave., L954, Aurora, CO, 80045, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Ave., L954, Aurora, CO, 80045, USA.,Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - David Andrew Mong
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Ave., L954, Aurora, CO, 80045, USA.,Children's Hospital of Colorado, Aurora, CO, USA
| | - Jason P Weinman
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Ave., L954, Aurora, CO, 80045, USA.,Children's Hospital of Colorado, Aurora, CO, USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado School of Medicine, 12401 E. 17th Ave., L954, Aurora, CO, 80045, USA.,Children's Hospital of Colorado, Aurora, CO, USA
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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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Secinaro A, Curione D, Mortensen KH, Santangelo TP, Ciancarella P, Napolitano C, Del Pasqua A, Taylor AM, Ciliberti P. Dual-source computed tomography coronary artery imaging in children. Pediatr Radiol 2019; 49:1823-1839. [PMID: 31440884 DOI: 10.1007/s00247-019-04494-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/11/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Abstract
Computed tomography (CT) has a well-established diagnostic role in the assessment of coronary arteries in adults. However, its application in a pediatric setting is still limited and often impaired by several technical issues, such as high heart rates, poor patient cooperation, and radiation dose exposure. Nonetheless, CT is becoming crucial in the noninvasive approach of children affected by coronary abnormalities and congenital heart disease. In some circumstances, CT might be preferred to other noninvasive techniques such as echocardiography and MRI for its lack of acoustic window influence, shorter acquisition time, and high spatial resolution. The introduction of dual-source CT has expanded the role of CT in the evaluation of pediatric cardiovascular anatomy and pathology. Furthermore, technical advances in the optimization of low-dose protocols represent an attractive innovation. Dual-source CT can play a key role in several clinical settings in children, namely in the evaluation of children with suspected congenital coronary artery anomalies, both isolated and in association with congenital heart disease. Moreover, it can be used to assess acquired coronary artery abnormalities, as in children with Kawasaki disease and after surgical manipulation, especially in case of transposition of the great arteries treated with arterial switch operation and in case of coronary re-implantation.
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Affiliation(s)
- Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Davide Curione
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Teresa Pia Santangelo
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciancarella
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carmela Napolitano
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessia Del Pasqua
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrew Mayall Taylor
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College of London, Great Ormond Street Hospital for Children, London, UK
| | - Paolo Ciliberti
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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8
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Third-generation dual-source dual-energy CT in pediatric congenital heart disease patients: state-of-the-art. Radiol Med 2019; 124:1238-1252. [DOI: 10.1007/s11547-019-01097-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
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9
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Kromrey ML, Hori M, Goshima S, Kozaka K, Hyodo T, Nakamura Y, Nishie A, Tamada T, Shimizu T, Kanki A, Motosugi U. Gadoxetate disodium-related event during image acquisition: a prospective multi-institutional study for better MR practice. Eur Radiol 2019; 30:281-290. [DOI: 10.1007/s00330-019-06358-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/21/2019] [Accepted: 07/03/2019] [Indexed: 12/16/2022]
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Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Image quality and radiation dose of ECG-triggered High-Pitch Dual-Source cardiac computed tomography angiography in children for the evaluation of central vascular stents. Int J Cardiovasc Imaging 2019; 35:367-374. [PMID: 30684082 DOI: 10.1007/s10554-019-01539-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Assess image quality and radiation dose of ECG-triggered High-Pitch Dual-Source CTA for the evaluation central vascular stents in children. We included all children ≤ 21 years old with one or more central vascular stents and available prospective ECG-triggered High-Pitch Dual-Source CTA performed at our institution between January 2015 and August 2017. Demographic and scanner information was retrieved. Two board-certified pediatric radiologists blinded to the clinical data, independently reviewed and scored each case using a four-point quality score. Scores 1, 2 and 3 were considered of diagnostic image quality. Inter-observer agreement and non-parametric test were used. 18 patients (10 girls, 8 boys) with a mean age of 9.47 ± 7.38 years (mean ± SD) met inclusion criteria. Thirty-two central vascular stents were evaluated. Mean quality score was 2.07 ± 0.94 with 12.5% (4/32) of the cases classified as unevaluable. Interobserver agreement was excellent (k = 0.86). There is no significant difference between quality score and stent location (p = 0.07). There is a significant difference with stent material as all non-diagnostic scores were only seen in covered stents made of platinum-iridium (p < 0.001). There was no association between image quality and age, height, weight, BSA, heart rate, radiation dose or stent lumen size (p > 0.05). ECG-triggered high-pitch spiral DS-CTA offers appropriate image quality for assessment of central vascular stents in children.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Saul
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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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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Rashed M, Banka P, Barthur A, MacDougal RD, Rathod RH, Powell AJ, Prakash A. Effects of Dose Reduction on Diagnostic Image Quality of Coronary Computed Tomography Angiography in Children Using a Third-Generation Dual-Source Computed Tomography Scanner. Am J Cardiol 2018; 122:1260-1264. [PMID: 30075893 DOI: 10.1016/j.amjcard.2018.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 11/26/2022]
Abstract
Performing coronary computed tomography angiography (CCTA) using third-generation dual source computed tomography (3G-DSCT) scanners results in radiation dose reduction without sacrificing image quality in adults. The largest dose reductions have been reported with prospectively gated, high-pitch imaging. However, there are limited data to determine if these benefits extend to pediatric patients. We evaluated image quality and radiation dose range of CCTA performed in children using a 3G-DSCT scanner. A retrospective review of 44 children (median age 10years, range 0.6 to 17) who underwent imaging to evaluate coronary artery origins (n = 27), Kawasaki disease (n = 12) or other coronary abnormalities (n = 5) were performed. General anesthesia was used in 9/44 (20%) patients and a β blocker was administered in 19/44 (43%). Prospectively gated high-pitch scanning was most frequently used (n = 24). Other techniques used included prospectively-gated "step and shoot" (n = 14), retrospectively gated (n = 2) and nongated high-pitch scan (n = 4). Median effective radiation doses were lowest for prospectively gated high-pitch scans (0.5mSv, range 0.4 to 0.7). Overall coronary artery image quality grade (1-excellent and 4-nondiagnostic) was acceptable for all electrocardiography-gated techniques, with no significant differences between high-pitch and "step-and-shoot" scan types (median 1, range 1 to 3 vs median 1, range 1 to 4, p = 0.22). Image quality grade was diagnostic (1 to 3) for all proximal coronary segments but rare distal segments were nondiagnostic (0.8% segments for gated high-pitch scan). In conclusion, CCTA can be performed in children using 3G-DSCT scanners withacceptable image quality. Prospectively gated high-pitch scans deliver the lowest radiation dose without reduction in image quality compared with conventional scan techniques.
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Affiliation(s)
- Moustafa Rashed
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ashita Barthur
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert D MacDougal
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Barrera CA, Otero HJ, White AM, Saul D, Biko DM. Depiction of the native coronary arteries during ECG-triggered High-Pitch Dual-Source Coronary Computed Tomography Angiography in children: Determinants of image quality. Clin Imaging 2018; 52:240-245. [PMID: 30142610 DOI: 10.1016/j.clinimag.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Assess the image quality of ECG-triggered High-Pitch Dual-Source CTA for the evaluation of native coronaries in children. MATERIALS AND METHODS Between August 2014 and September 2017, 45 children with morphologically normal cardiac chambers had cardiac prospective ECG-triggered High-Pitch Dual-Source CTA. Two pediatric radiologists blinded to clinical data, independently reviewed each case. The coronary arteries were evaluated using a four-point scale quality score according to the coronary segment. Attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured using values from the air, inter-ventricular septum and ascending aorta at the level of the sinuses of Valsalva. RESULTS 225 coronary segments were assessed showed a mean score of 2.40 ± 0.73, 94.2% had diagnostic image quality. The best and worst average quality were seen in segment 5 and 2, respectively. Inter-observer agreement was moderate for all segments except for segment 1, which was excellent. Worse quality scores were significantly associated with younger patients and low body mass index as well as with higher heart rates in all segments. The mean observed heart rate and BSA in patients with diagnostic image quality were below 77 bpm and over 1.4 m2 respectively. There is no significant association between attenuation, SNR and CNR with image quality. CONCLUSIONS Prospective ECG-triggered High-Pitch Dual-Source Computed Tomography Angiography achieves consistent and diagnostic image quality for coronary artery assessment at a low effective dose in pediatric patients.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Hansel J Otero
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Ammie M White
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - David Saul
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
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Tang Z. Application of double low dose combined low flow injection in coronary dual-source coronary computed tomography angiography. Echocardiography 2018; 35:1442-1447. [PMID: 29864195 DOI: 10.1111/echo.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This study was aimed to explore the feasibility of lower tube voltage, low volumes of contrast medium, and low flow injection in prospective electrocardiogram (ECG)-triggered high-pitch dual-source coronary computed tomography angiography (CCTA) for coronary artery imaging. MATERIAL AND METHODS A total of 140 patients with body mass index (BMI) ranging from 18.5 to 24.3 kg/m2 and heart rate (HR) lower than 65 times/min underwent CCTA were divided randomly into two groups. The enhanced CT value and noise as well as signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Coronary artery was evaluated by double-blind method using a four-point grading scale. RESULTS No significant differences were found in the average enhanced CT value, noise, SNR, and CNR of all segments between the two groups (P > .05). Meanwhile, effective radiation dosages in group A were markedly lower than those in group B (P < .01). CONCLUSION The prospective ECG-triggered high-pitch dual-source CCTA with low voltage, contrast medium, and flow rate injection using sinogram affirmed iterative reconstruction is feasible which can observably reduce radiation and obtain satisfactory images.
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Affiliation(s)
- Zhenhua Tang
- Department of Medical Imaging, Xin Tai People's Hospital, Taian, China
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