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Cho HH, Lee SM, You SK. Assessment of deep learning image reconstruction (DLIR) on image quality in pediatric cardiac CT datasets type of manuscript: Original research. PLoS One 2024; 19:e0300090. [PMID: 39186484 PMCID: PMC11346658 DOI: 10.1371/journal.pone.0300090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 08/28/2024] Open
Abstract
BAKGROUND To evaluate the quantitative and qualitative image quality using deep learning image reconstruction (DLIR) of pediatric cardiac computed tomography (CT) compared with conventional image reconstruction methods. METHODS Between January 2020 and December 2022, 109 pediatric cardiac CT scans were included in this study. The CT scans were reconstructed using an adaptive statistical iterative reconstruction-V (ASiR-V) with a blending factor of 80% and three levels of DLIR with TrueFidelity (low-, medium-, and high-strength settings). Quantitative image quality was measured using signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The edge rise distance (ERD) and angle between 25% and 75% of the line density profile were drawn to evaluate sharpness. Qualitative image quality was assessed using visual grading analysis scores. RESULTS A gradual improvement in the SNR and CNR was noted among the strength levels of the DLIR in sequence from low to high. Compared to ASiR-V, high-level DLIR showed significantly improved SNR and CNR (P<0.05). ERD decreased with increasing angle as the level of DLIR increased. CONCLUSION High-level DLIR showed improved SNR and CNR compared to ASiR-V, with better sharpness on pediatric cardiac CT scans.
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Affiliation(s)
- Hyun-Hae Cho
- Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea
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Wu Z, Han Q, Liang Y, Zheng Z, Wu M, Ai Z, Ma K, Xiang Z. Enhancing diagnostic performance and image quality in coronary CT angiography: Impact of SnapShot Freeze 2 algorithm across varied heart rates in stent patients. J Appl Clin Med Phys 2024; 25:e14412. [PMID: 38807292 PMCID: PMC11302822 DOI: 10.1002/acm2.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE To investigate the enhancement of image quality achieved through the utilization of SnapShot Freeze 2 (SSF2), a comparison was made against the results obtained from the original SnapShot Freeze algorithm (SSF) and standard motion correction (STND) in stent patients undergoing coronary CT angiography (CCTA) across the entire range of heart rates. MATERIALS AND METHODS A total of 118 patients who underwent CCTA, were retrospectively included in this study. Images of these patients were reconstructed using three different algorithms: SSF2, SSF, and STND. Objective assessments include signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diameters of stents and artifact index (AI). The image quality was subjectively evaluated by two readers. RESULTS Compared with SSF and STND, SSF2 had similar or even higher quality in the parameters (AI, SNR, CNR, inner diameters) of coronary artery, stent, myocardium, MV (mitral valve), TV (tricuspid valve), AV (aorta valve), and PV (pulmonary valve), and aortic root (AO). Besides the above structures, SSF2 also demonstrated comparable or even higher subjective scores in atrial septum (AS), ventricular septum (VS), and pulmonary artery root (PA). Furthermore, the enhancement in image quality with SSF2 was significantly greater in the high heart rate group compared to the low heart rate group. Moreover, the improvement in both high and low heart rate groups was better in the SSF2 group compared to the SSF and STND group. Besides, when using the three algorithms, an effect of heart rate variability on stent image quality was not detected. CONCLUSION Compared to SSF and STND, SSF2 can enhance the image quality of whole-heart structures and mitigate artifacts of coronary stents. Furthermore, SSF2 has demonstrated a significant improvement in the image quality for patients with a heart rate equal to or higher than 85 bpm.
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Affiliation(s)
- Zhehao Wu
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central HospitalGuangzhouChina
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Qijia Han
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Yuying Liang
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Zhijuan Zheng
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central HospitalGuangzhouChina
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Minyi Wu
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Zhu Ai
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
| | - Kun Ma
- CT Imaging Research CenterGE HealthCare ChinaGuangzhouChina
| | - Zhiming Xiang
- Department of RadiologyGuangzhou Panyu Central HospitalGuangzhouChina
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Festa P, Lovato L, Bianco F, Alaimo A, Angeli E, Baccano G, Barbi E, Bennati E, Bonhoeffer P, Bucciarelli V, Curione D, Ciliberti P, Clemente A, Di Salvo G, Esposito A, Ferroni F, Gaeta A, Giovagnoni A, Inserra MC, Leonardi B, Marcora S, Marrone C, Peritore G, Pergola V, Pluchinotta F, Puppini G, Stagnaro N, Raimondi F, Sandrini C, Spaziani G, Tchana B, Trocchio G, Ait-Ali L, Secinaro A. Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (Part II). J Cardiovasc Med (Hagerstown) 2024; 25:473-487. [PMID: 38829936 DOI: 10.2459/jcm.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. This is the second of two complementary documents, endorsed by experts from the Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, aimed at giving updated indications on the appropriate use of CMR and CCT in different clinical CHD settings, in both pediatrics and adults. In this article, support is also given to radiologists, pediatricians, cardiologists, and cardiac surgeons for indications and appropriateness criteria for CMR and CCT in the most referred CHD, following the proposed new criteria presented and discussed in the first document. This second document also examines the impact of devices and prostheses for CMR and CCT in CHD and additionally presents some indications for CMR and CCT exams when sedation or narcosis is needed.
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Affiliation(s)
- Pierluigi Festa
- Pediatric Cardiology and GUCH Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Massa-Pisa
| | - Luigi Lovato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, Bologna
| | - Francesco Bianco
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
| | - Annalisa Alaimo
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- U.O.C. di Cardiologia Pediatrica, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Emanuela Angeli
- Pediatric & Grown-up Congenital Cardiac Surgery Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna
| | - Giovanna Baccano
- Department of Pediatric Cardiology - Centro Cardiologico Pediatrico Mediterraneo, Taormina
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo'
- Department of Pediatrics, University of Trieste, Trieste
| | - Elena Bennati
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | | | - Valentina Bucciarelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
| | - Davide Curione
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital
| | - Paolo Ciliberti
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Alberto Clemente
- UOC Imaging Multimodale Cardiovascolare e Neuroradiologico - Dipartimento Immagini, Fondazione Toscana 'Gabriele Monasterio'/CNR - Pisa
| | - Giovanni Di Salvo
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Department of Women's and Children's Health, University of Padua, Padua
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center IRCCS Ospedale San Raffaele, Milan
| | | | - Alberto Gaeta
- Radiology Unit, Pediatric Hospital Giovanni XXIII, Bari
| | - Andrea Giovagnoni
- Radiology department, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
| | - Maria Cristina Inserra
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Radiologia 2 - Centro Alta Specialità e Trapianti (C.A.S.T.), Azienda Ospedaliero Universitaria Policlinico San Marco. Catania
| | - Benedetta Leonardi
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Simona Marcora
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- USSD Cardiologia Pediatrica, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Massa-Pisa
| | - Giuseppe Peritore
- U.O.C. di Radiodiagnostica, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua
| | - Francesca Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Milan
| | | | | | - Francesca Raimondi
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | - Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Gaia Spaziani
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | - Bertrand Tchana
- Department of Pediatrics, Ospedale dei Bambini Barilla, University of Parma, Parma
| | | | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
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Donthula R, Li W, Duvvada A, Dyer D, Uppu SC. Normative Computed Tomography Angiography Values of the Aortic Root, Aorta and Aortic arch in Children. RESEARCH SQUARE 2024:rs.3.rs-4406785. [PMID: 38798643 PMCID: PMC11118707 DOI: 10.21203/rs.3.rs-4406785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Purpose Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data are not currently available for ECG-gated Computed Tomography Angiography (CTA). We sought to establish ECG-gated CTA derived normative values for the aortic root, aorta and aortic arch in children. Methods and Results Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface areaAE (BSAAE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. Conclusion Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta and aortic arch in children.
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Affiliation(s)
| | - Wen Li
- the University of Texas McGovern Medical School at Houston
| | | | | | - Santosh C Uppu
- The University of Texas Health Science Center at Houston
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Renz DM, Böttcher J, Eckstein J, Huisinga C, Pfeil A, Lücke C, Gutberlet M. [Imaging of congenital heart defects with a focus on magnetic resonance imaging and computed tomography]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:382-391. [PMID: 38656344 DOI: 10.1007/s00117-024-01301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
CLINICAL ISSUE Due to advances in diagnostics and therapy, the survival rate of patients with congenital heart defects is continuously increasing. The aim of this review is to compare various imaging modalities that are used in the diagnosis of congenital heart defects. METHODS Transthoracic echocardiography is the imaging method of choice in the presence of a congenital heart defect because of its wide availability and non-invasiveness. It can be complemented by transesophageal echocardiography, cardiac catheterization, computed tomography (CT), and magnetic resonance imaging (MRI) of the heart and vessels close to the heart. METHODICAL INNOVATIONS The radiation exposure of CT examinations of the heart is continuously decreasing because of improved technologies. MRI is also being continuously optimized, e.g., by the acquisition of MR angiographies without contrast medium application or a thin three-dimensional (3D) visualization of the entire heart with the possibility of reconstruction in all spatial planes (whole-heart technique) as well as 2D to 4D flow. PRACTICAL RECOMMENDATION Due to the complexity of congenital heart defects and the variety of possible pathologies, the choice of imaging modality and its exact performance has to be coordinated in an interdisciplinary context and individually adapted.
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Affiliation(s)
- Diane Miriam Renz
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | | | - Jan Eckstein
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Carolin Huisinga
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Lücke
- Abteilung für Diagnostische und Interventionelle Radiologie, Universität Leipzig - Herzzentrum Leipzig, Leipzig, Deutschland
| | - Matthias Gutberlet
- Abteilung für Diagnostische und Interventionelle Radiologie, Universität Leipzig - Herzzentrum Leipzig, Leipzig, Deutschland
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Epstein R, Yomogida M, Donovan D, Butensky A, Aidala AA, Farooqi KM, Shah AM, Chelliah A, DiLorenzo MP. Trends in cardiac CT utilization for patients with pediatric and congenital heart disease: A multicenter survey study. J Cardiovasc Comput Tomogr 2024; 18:267-273. [PMID: 38360501 DOI: 10.1016/j.jcct.2024.02.002] [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: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. METHODS A 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. RESULTS Forty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. CONCLUSION While CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances.
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Affiliation(s)
- Rebecca Epstein
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
| | - Maiko Yomogida
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Denis Donovan
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Adam Butensky
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Angela A Aidala
- Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Kanwal M Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Amee M Shah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Anjali Chelliah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA; Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Michael P DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
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Cheong D, Alloah Q, Fishbein JS, Rajagopal HG. Comparison and Agreement between Cardiovascular Computed Tomography-Derived Mid-Diastolic and End-Diastolic Ventricular Volume in Patients with Congenital Heart Disease. Pediatr Cardiol 2024:10.1007/s00246-024-03504-x. [PMID: 38689021 DOI: 10.1007/s00246-024-03504-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: 02/13/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m2, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m2, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.
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Affiliation(s)
- Daniel Cheong
- Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA.
| | - Qais Alloah
- Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA
| | - Joanna S Fishbein
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, USA
| | - Hari G Rajagopal
- Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA
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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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Yoshiura T, Masuda T, Tahara M, Kobayashi Y, Kikuhara Y, Ishibashi T, Nonaka H, Oku T, Sato T, Funama Y. Cardiac computed tomography angiography with and without bolus tracking methods in infants with congenital heart disease. RADIATION PROTECTION DOSIMETRY 2024; 200:251-258. [PMID: 38088430 DOI: 10.1093/rpd/ncad295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 10/12/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
The study investigated radiation dose, vascular computed tomography (CT) enhancement and image quality of cardiac computed tomography angiography (CCTA) with and without bolus tracking (BT) methods in infants with congenital heart disease (CHD). The volume CT dose index (CTDIvol) and dose length product (DLP) were recorded for all CT scans, and the effective dose was obtained using a conversion factors. The CT number for the ascending aorta (AO) and pulmonary artery (PA), image noise of muscle tissue and contrast-to-noise ratio (CNR) were measured and calculated. The median values in the groups with and without BT were 2.20 mGy versus 0.44 mGy for CTDIvol, 8.10 mGy·cm versus 6.20 mGy·cm for DLP, and 0.66 mSv versus 0.51 mSv for effective dose (p < 0.001). There were no statistical differences in vascular CT enhancement, image noise, and CNR. CCTA without BT methods can reduce the radiation dose while maintaining vascular CT enhancement and image quality compared to CCTA with BT methods.
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Affiliation(s)
- Takayuki Yoshiura
- Graduate School of Health Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Takanori Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki-City, Okayama, 701-0193, Japan
| | - Masahiro Tahara
- Hiroshima Central Street Children's Clinic, 7-1 Mikawa-cho, Hiroshima, 730-0029, Japan
| | - Yukie Kobayashi
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Yukari Kikuhara
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Toru Ishibashi
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Haruki Nonaka
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Takayuki Oku
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Tomoyasu Sato
- Department of Medical Technology, Tsuchiya General Hospital, 3-30 Nakajima-cho, Hiroshima, 730-8655, Japan
| | - Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan
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10
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Donthula R, Li W, Kaur H, Adebo DA, Uppu SC. Normative computed tomography angiography values of the main and branch pulmonary arteries in children. Eur J Pediatr 2024; 183:1183-1193. [PMID: 38078969 DOI: 10.1007/s00431-023-05363-9] [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: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
Non-invasive cardiac imaging like echocardiogram, cardiac magnetic resonance imaging (CMR), and computed tomography angiography (CTA) play a key role in the diagnosis, aid in management and follow-up of congenital heart disease patients. Normative data for intracardiac and extracardiac vascular structures in children are currently available for echocardiogram, CMR, and non-gated CTA. We sought to establish systolic and diastolic normative data for main and branch pulmonary arteries in children using electrocardiogram (ECG)-gated CTA. Diameters and cross-sectional areas of the main and branch pulmonary arteries were measured in systole and diastole based on the aortic valve position (open versus closed) in 100 subjects who had ECG-gated cardiac CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area (BSAAE) was established using the previously described methods. A total of 100 children aged 0-18 years were analyzed; mean age was 5.3 years (SD, 6.1 years). Z-score curves were plotted in relation to the BSA for the mean, maximum, and minimum diameters and cross-sectional area of the main and branch pulmonary arteries for systole and diastole. Conclusion: We report systolic and diastolic mean, maximum, and minimum diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children derived using ECG-gated cardiac CTA. We believe our results can help identify abnormally sized main and branch pulmonary arteries. What is Known: • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity. What is New: • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children.
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Affiliation(s)
- Rakesh Donthula
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas McGovern Medical School at Houston, Houston, TX, 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Harmanpreet Kaur
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Santosh C Uppu
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA.
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11
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Floria M, Burlacu A, Morariu PC, Oancea AF, Iov DE, Baroi GL, Stafie CS, Scripcariu V, Tănase DM. Multimodality Imaging in Right Heart Tumors: Proposed Algorithm towards an Appropriate Diagnosis. J Clin Med 2024; 13:1000. [PMID: 38398314 PMCID: PMC10888584 DOI: 10.3390/jcm13041000] [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: 01/07/2024] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
A right heart tumor can be identified by transthoracic echocardiography during a routine examination or due to cardiac symptoms. The first step is the assessment by echocardiography, with its multiple techniques, and the obtained information must be judged in a clinical and biological context. The second step comprises one, sometimes even two, of the more complex modality imaging methods. The choice is driven not only by the advantages of each imaging technique but also by local expertise or the preferred imaging modality in the center. This step is followed by staging, follow-up, and/or imaging-guided excision or biopsy, which is performed in selected cases in order to obtain anatomopathological confirmation. In the presence of features suggestive of malignancy or causing hemodynamic impairment, a transvenous biopsy is essential before the more complex imaging modalities (which are still relevant in the staging process). Using a structured imaging approach, it is possible to reach an appropriate diagnosis without a biopsy. Frequently, these imaging techniques have a complementary role, so an integrated imaging approach is recommended. This proposed algorithm for appropriate diagnosis of right heart tumors could serve as a practical guide for clinicians (not only imaging specialists).
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Affiliation(s)
- Mariana Floria
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (M.F.); (A.B.); (P.C.M.); (A.-F.O.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Alexandru Burlacu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (M.F.); (A.B.); (P.C.M.); (A.-F.O.); (D.M.T.)
- Institute of Cardiovascular Diseases, 700503 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (M.F.); (A.B.); (P.C.M.); (A.-F.O.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Alexandru-Florinel Oancea
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (M.F.); (A.B.); (P.C.M.); (A.-F.O.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Diana-Elena Iov
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (M.F.); (A.B.); (P.C.M.); (A.-F.O.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
| | - Genoveva Livia Baroi
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania;
| | - Celina Silvia Stafie
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Viorel Scripcariu
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania;
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Daniela Maria Tănase
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (M.F.); (A.B.); (P.C.M.); (A.-F.O.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania;
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12
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Zoghbi WA, Jone PN, Chamsi-Pasha MA, Chen T, Collins KA, Desai MY, Grayburn P, Groves DW, Hahn RT, Little SH, Kruse E, Sanborn D, Shah SB, Sugeng L, Swaminathan M, Thaden J, Thavendiranathan P, Tsang W, Weir-McCall JR, Gill E. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024; 37:2-63. [PMID: 38182282 DOI: 10.1016/j.echo.2023.10.004] [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: 01/07/2024]
Abstract
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.
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Affiliation(s)
- William A Zoghbi
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas.
| | - Pei-Ni Jone
- Lurie Children's Hospital, Northwestern University, Chicago, Illinois
| | | | - Tiffany Chen
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Grayburn
- Baylor Scott & White Health, University of Texas Southwestern, Dallas, Texas
| | - Daniel W Groves
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | - Stephen H Little
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas
| | - Eric Kruse
- University of Chicago Medical Center, Chicago, Illinois
| | | | - Sangeeta B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
| | - Madhav Swaminathan
- Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, North Carolina
| | | | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
| | | | - Edward Gill
- University of Colorado School of Medicine, Aurora, Colorado
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13
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Kardos M, Curione D, Valverde I, van Schuppen J, Goo HW, Kellenberger CJ, Secinaro A, Caro-Domínguez P. Pediatric Cardiovascular Computed Tomography: Clinical Indications, Technique, and Standardized Reporting. Recommendations From the Cardiothoracic Taskforce of the European Society of Pediatric Radiology. J Thorac Imaging 2024; 39:18-33. [PMID: 37884389 DOI: 10.1097/rti.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Congenital heart diseases affect 1% of all live births in the general population. The prognosis of these children is increasingly improving due to advances in medical care and surgical treatment. Imaging is also evolving rapidly to assess accurately complex cardiac anomalies prenatally and postnatally. Transthoracic echocardiography is the gold-standard imaging technique to diagnose and follow-up children with congenital heart disease. Cardiac computed tomography imaging plays a key role in the diagnosis of children with congenital heart defects that require intervention, due to its high temporal and spatial resolution, with low radiation doses. It is challenging for radiologists, not primarily specialized in this field, to perform and interpret these studies due to the difficult anatomy, physiology, and postsurgical changes. Technical challenges consist of necessary electrocardiogram gating and contrast bolus timing to obtain an optimal examination. This article aims to define indications for pediatric cardiac computed tomography, to explain how to perform and report these studies, and to discuss future applications of this technique.
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Affiliation(s)
- Marek Kardos
- Department of Functional Diagnostics, Children's Cardiac Center, Bratislava, Slovakia
| | - Davide Curione
- Department of Imaging, Advanced Cardiothoracic Imaging Unit, Pediatric Hospital Bambino Gesu, Rome, Italy
| | - Israel Valverde
- Department of Radiology, Pediatric Radiology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital-Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asian Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiothoracic Imaging Unit, Pediatric Hospital Bambino Gesu, Rome, Italy
| | - Pablo Caro-Domínguez
- Department of Radiology, Pediatric Radiology Unit, Virgen del Rocio University Hospital, Seville, Spain
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14
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Han BK, Garcia S, Aboulhosn J, Blanke P, Martin MH, Zahn E, Crean A, Overman D, Craig CH, Hanneman K, Semple T, Armstrong A. Technical recommendations for computed tomography guidance of intervention in the right ventricular outflow tract: Native RVOT, conduits and bioprosthetic valves:: A white paper of the Society of Cardiovascular Computed Tomography (SCCT), Congenital Heart Surgeons' Society (CHSS), and Society for Cardiovascular Angiography & Interventions (SCAI). J Cardiovasc Comput Tomogr 2024; 18:75-99. [PMID: 37517984 DOI: 10.1016/j.jcct.2023.06.005] [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: 11/21/2022] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023]
Abstract
This consensus document for the performance of Cardiovascular Computed Tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multi-modality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.
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Affiliation(s)
- B Kelly Han
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education and the Christ Hospital, Cincinnati, Ohio, USA
| | - Jamil Aboulhosn
- University of California Los Angeles (UCLA) Health, Los Angeles, California, USA
| | - Phillip Blanke
- St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Mary Hunt Martin
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Evan Zahn
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, California, USA
| | - Andrew Crean
- University of Ottawa Heart Institute, Ottawa, Canada
| | - David Overman
- The Children's Heart Clinic, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA
| | - C Hamilton Craig
- University of Queensland and Griffith University, Queensland, New Zealand
| | | | - Thomas Semple
- The Royal Brompton Hospital, London, England, United Kingdom
| | - Aimee Armstrong
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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15
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Kelly Han B, Binka E, Griffiths E, Hobbs R, Eckhauser A, Husain A, Overman D. Left Ventricular Outflow Tract Obstruction in Congenital Heart Disease: The Role of Cardiovascular Computed Tomography in Surgical Decision Making. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 27:11-18. [PMID: 38522866 DOI: 10.1053/j.pcsu.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 03/26/2024]
Abstract
Patients with many forms of congenital heart disease (CHD) and hypertrophic cardiomyopathy undergo surgical intervention to relieve left ventricular outflow tract obstruction (LVOTO). Cardiovascular Computed Tomography (CCT) defines the complex pathway from the ventricle to the outflow tract and can be visualized in 2D, 3D, and 4D (3D in motion) to help define the mechanism and physiologic significance of obstruction. Advanced cardiac visualization may aid in surgical planning to relieve obstruction in the left ventricular outflow tract, aortic or neo-aortic valve and the supravalvular space. CCT scanner technology has advanced to achieve submillimeter, isotropic spatial resolution, temporal resolution as low as 66 msec allowing high-resolution imaging even at the fast heart rates and small cardiac structures of pediatric patients ECG gating techniques allow radiation exposure to be targeted to a minimal portion of the cardiac cycle for anatomic imaging, and pulse modulation allows cine imaging with a fraction of radiation given during most of the cardiac cycle, thus reducing radiation dose. Scanning is performed in a single heartbeat or breath hold, minimizing the need for anesthesia or sedation, for which CHD patents are highest risk for an adverse event. Examples of visualization of complex left ventricular outflow tract obstruction in the subaortic, valvar and supravalvular space will be highlighted, illustrating the novel applications of CCT in this patient subset.
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Affiliation(s)
- B Kelly Han
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
| | - Edem Binka
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Eric Griffiths
- Division of Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Reilly Hobbs
- Division of Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Aaron Eckhauser
- Division of Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - David Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minnesota
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16
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Xu X, Jia Q, Yuan H, Qiu H, Dong Y, Xie W, Yao Z, Zhang J, Nie Z, Li X, Shi Y, Zou JY, Huang M, Zhuang J. A clinically applicable AI system for diagnosis of congenital heart diseases based on computed tomography images. Med Image Anal 2023; 90:102953. [PMID: 37734140 DOI: 10.1016/j.media.2023.102953] [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: 12/19/2022] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
Congenital heart disease (CHD) is the most common type of birth defect. Without timely detection and treatment, approximately one-third of children with CHD would die in the infant period. However, due to the complicated heart structures, early diagnosis of CHD and its types is quite challenging, even for experienced radiologists. Here, we present an artificial intelligence (AI) system that achieves a comparable performance of human experts in the critical task of classifying 17 categories of CHD types. We collected the first-large CT dataset from three different CT machines, including more than 3750 CHD patients over 14 years. Experimental results demonstrate that it can achieve diagnosis accuracy (86.03%) comparable with junior cardiovascular radiologists (86.27%) in a World Health Organization appointed research and cooperation center in China on most types of CHD, and obtains a higher sensitivity (82.91%) than junior cardiovascular radiologists (76.18%). The accuracy of the combination of our AI system (97.20%) and senior radiologists achieves comparable results to that of junior radiologists and senior radiologists (97.16%) which is the current clinical routine. Our AI system can further provide 3D visualization of hearts to senior radiologists for interpretation and flexible review, surgeons for precise intuition of heart structures, and clinicians for more precise outcome prediction. We demonstrate the potential of our model to be integrated into current clinic practice to improve the diagnosis of CHD globally, especially in regions where experienced radiologists can be scarce.
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Affiliation(s)
- Xiaowei Xu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Qianjun Jia
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Catheterization Lab, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haiyun Yuan
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Hailong Qiu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yuhao Dong
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Catheterization Lab, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wen Xie
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zeyang Yao
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Jiawei Zhang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zhiqaing Nie
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Xiaomeng Li
- Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology, Hong Kong Special Administrative Region
| | - Yiyu Shi
- Computer Science and Engineering, University of Notre Dame, IN, 46656, USA
| | - James Y Zou
- Department of Computer Science, Stanford University, Stanford, CA, 94305, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA.
| | - Meiping Huang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Catheterization Lab, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Jian Zhuang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
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17
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Krishnamurthy R, Suman G, Chan SS, Kirsch J, Iyer RS, Bolen MA, Brown RKJ, El-Sherief AH, Galizia MS, Hanneman K, Hsu JY, de Rosen VL, Rajiah PS, Renapurkar RD, Russell RR, Samyn M, Shen J, Villines TC, Wall JJ, Rigsby CK, Abbara S. ACR Appropriateness Criteria® Congenital or Acquired Heart Disease. J Am Coll Radiol 2023; 20:S351-S381. [PMID: 38040460 DOI: 10.1016/j.jacr.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Pediatric heart disease is a large and diverse field with an overall prevalence estimated at 6 to 13 per 1,000 live births. This document discusses appropriateness of advanced imaging for a broad range of variants. Diseases covered include tetralogy of Fallot, transposition of great arteries, congenital or acquired pediatric coronary artery abnormality, single ventricle, aortopathy, anomalous pulmonary venous return, aortopathy and aortic coarctation, with indications for advanced imaging spanning the entire natural history of the disease in children and adults, including initial diagnosis, treatment planning, treatment monitoring, and early detection of complications. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Garima Suman
- Research Author, Mayo Clinic, Rochester, Minnesota
| | | | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington
| | | | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | | | | | | | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island; American Society of Nuclear Cardiology
| | - Margaret Samyn
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Society for Cardiovascular Magnetic Resonance
| | - Jody Shen
- Stanford University, Stanford, California
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Jessica J Wall
- University of Washington, Seattle, Washington; American College of Emergency Physicians
| | - Cynthia K Rigsby
- Specialty Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Suhny Abbara
- Specialty Chair, University of Texas Southwestern Medical Center, Dallas, Texas
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18
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Han BK, Garcia S, Aboulhosn J, Blanke P, Martin MH, Zahn E, Crean A, Overman D, Hamilton Craig C, Hanneman K, Semple T, Armstrong A. Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves. World J Pediatr Congenit Heart Surg 2023; 14:761-791. [PMID: 37647270 PMCID: PMC10685707 DOI: 10.1177/21501351231186898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This consensus document for the performance of cardiovascular computed tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital heart disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons, and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multimodality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.
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Affiliation(s)
- B. Kelly Han
- University of Utah, Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education and The Christ Hospital, Cincinnati, OH, USA
| | - Jamil Aboulhosn
- University of California Los Angeles (UCLA) Health, Los Angeles, CA, USA
| | - Phillip Blanke
- St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Hunt Martin
- University of Utah, Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Evan Zahn
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, CA, USA
| | - Andrew Crean
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David Overman
- The Children’s Heart Clinic, Children’s Minnesota, Mayo Clinic-Children’s Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | - C. Hamilton Craig
- University of Queensland and Griffith University, Queensland, Australia
| | | | | | - Aimee Armstrong
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
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19
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Han BK, Garcia S, Aboulhosn J, Blanke P, Martin MH, Zahn E, Crean A, Overman D, Craig CH, Hanneman K, Semple T, Armstrong A. Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits and Bioprosthetic Valves: A White Paper of the Society of Cardiovascular Computed Tomography (SCCT), Congenital Heart Surgeons' Society (CHSS), and Society for Cardiovascular Angiography & Interventions (SCAI). JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101117. [PMID: 39129907 PMCID: PMC11307962 DOI: 10.1016/j.jscai.2023.101117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 08/13/2024]
Abstract
This consensus document for the performance of cardiovascular computed tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multi-modality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.
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Affiliation(s)
- B. Kelly Han
- University of Utah, Intermountain Primary Children’s Hospital, Salt Lake City, Utah
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education and The Christ Hospital, Cincinnati, Ohio
| | - Jamil Aboulhosn
- University of California Los Angeles (UCLA) Health, Los Angeles, California
| | - Phillip Blanke
- St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Hunt Martin
- University of Utah, Intermountain Primary Children’s Hospital, Salt Lake City, Utah
| | - Evan Zahn
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, California
| | - Andrew Crean
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David Overman
- The Children’s Heart Clinic, Children’s Minnesota, Mayo Clinic-Children’s Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota
| | - C. Hamilton Craig
- University of Queensland and Griffith University, Queensland, New Zealand
| | | | - Thomas Semple
- The Royal Brompton Hospital, London, England, United Kingdom
| | - Aimee Armstrong
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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20
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Moscatelli S, Pergola V, Motta R, Fortuni F, Borrelli N, Sabatino J, Leo I, Avesani M, Montanaro C, Surkova E, Mapelli M, Perrone MA, di Salvo G. Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1747. [PMID: 38002838 PMCID: PMC10670209 DOI: 10.3390/children10111747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common complex congenital heart disease with long-term survivors, demanding serial monitoring of the possible complications that can be encountered from the diagnosis to long-term follow-up. Cardiovascular imaging is key in the diagnosis and serial assessment of TOF patients, guiding patients' management and providing prognostic information. Thorough knowledge of the pathophysiology and expected sequalae in TOF, as well as the advantages and limitations of different non-invasive imaging modalities that can be used for diagnosis and follow-up, is the key to ensuring optimal management of patients with TOF. The aim of this manuscript is to provide a comprehensive overview of the role of each modality and common protocols used in clinical practice in the assessment of TOF patients.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
- Department of Cardiology, Leiden University Medical Center, 2300 Leiden, The Netherlands
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas's NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Marco Alfonso Perrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni di Salvo
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
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Hassan A, Chegondi M, Porayette P. Five decades of Fontan palliation: What have we learned? What should we expect? J Int Med Res 2023; 51:3000605231209156. [PMID: 37910851 PMCID: PMC10621298 DOI: 10.1177/03000605231209156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
The Fontan procedure is the final palliative surgery in a series of staged surgeries to reroute the systemic venous blood flow directly to the lungs, with the ventricle(s) pumping oxygenated blood to the body. Advances in medical and surgical techniques have improved patients' overall survival after the Fontan procedure. However, Fontan-associated chronic comorbidities are common. In addition to chronic cardiac dysfunction and arrhythmias, complications involving other organs such as the liver, lungs, intestine, lymphatic system, brain, and blood frequently occur. This narrative review focuses on the immediate and late consequences in children, pregnant women, and other adults with Fontan circulation. In addition, we describe the technical advancements that might change the way single-ventricle patients are managed in future.
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Affiliation(s)
- Adil Hassan
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Madhuradhar Chegondi
- Division of Pediatric Critical Care Medicine, Stead Family Children’s Hospital, University of Iowa, Iowa City, IA 52242, USA
| | - Prashob Porayette
- Division of Pediatric Cardiology, Stead Family Children’s Hospital, University of Iowa, Iowa City, IA 52242, USA
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22
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Jepson BM, Rigsby CK, Hlavacek AM, Prakash A, Priya S, Barfuss S, Chelliah A, Binka E, Nicol E, Ghoshhajra B, Han BK. Proposed competencies for the performance of cardiovascular computed tomography in pediatric and adult congenital heart disease. J Cardiovasc Comput Tomogr 2023; 17:295-301. [PMID: 37625911 DOI: 10.1016/j.jcct.2023.08.002] [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: 06/06/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
Cardiovascular computed tomography (CCT) is rated appropriate by published guidelines for the initial evaluation and follow up of congenital heart disease (CHD) and is an essential modality in cardiac imaging programs for patients of all ages. However, no recommended core competencies exist to guide CCT in CHD imaging training pathways, curricula development, or establishment of a more formal educational platform. To fill this gap, a group of experienced congenital cardiac imagers, intentionally inclusive of adult and pediatric cardiologists and radiologists, was formed to propose core competencies fundamental to the expert-level performance of CCT in pediatric acquired and congenital heart disease and adult CHD. The 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography (1) for adult imaging were used as a framework to define pediatric and CHD-specific competencies. Established competencies will be immediately relevant for advanced cardiac imaging fellowships in both cardiology and radiology training pathways. Proposed future steps include radiology and cardiology society collaboration to establish provider certification levels, training case-volume recommendations, and continuing medical education (CME) requirements for expert-level performance of CCT in pediatric and adult CHD.
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Affiliation(s)
- Bryan M Jepson
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Cynthia K Rigsby
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anthony M Hlavacek
- Shawn Jenkins Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ashwin Prakash
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarv Priya
- University of Iowa Hospitals & Clinics, Carver College of Medicine, Iowa City, IA, USA
| | - Spencer Barfuss
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ and Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Edem Binka
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Edward Nicol
- Royal Brompton and Harefield Hospitals, Imperial College of London School of Medicine, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - B Kelly Han
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA.
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23
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Chelliah A, Nicol ED. Quality improvement in pediatric and congenital cardiac CT: A call to action. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00089-8. [PMID: 37019759 DOI: 10.1016/j.jcct.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Anjali Chelliah
- Department of Pediatrics, Division of Cardiology, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA; Department of Pediatrics, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Edward D Nicol
- Departments of Cardiology and Radiology, Royal Brompton Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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24
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Pickard SS, Armstrong AK, Balasubramanian S, Buddhe S, Crum K, Kong G, Lang SM, Lee MV, Lopez L, Natarajan SS, Norris MD, Parra DA, Parthiban A, Powell AJ, Priromprintr B, Rogers LS, Sachdeva S, Shah SS, Smith CA, Stern KWD, Xiang Y, Young LT, Sachdeva R. Appropriateness of cardiovascular computed tomography and magnetic resonance imaging in patients with conotruncal defects. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00048-5. [PMID: 36868899 DOI: 10.1016/j.jcct.2023.01.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 01/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To promote the rational use of cardiovascular imaging in patients with congenital heart disease, the American College of Cardiology developed Appropriate Use Criteria (AUC), but its clinical application and pre-release benchmarks have not been evaluated. We aimed to evaluate the appropriateness of indications for cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal defects and to identify factors associated with maybe or rarely appropriate (M/R) indications. METHODS Twelve centers each contributed a median of 147 studies performed prior to AUC publication (01/2020) on patients with conotruncal defects. To incorporate patient characteristics and center-level effects, a hierarchical generalized linear mixed model was used. RESULTS Of the 1753 studies (80% CMR, and 20% CCT), 16% were rated M/R. Center M/R ranged from 4 to 39%. Infants accounted for 8.4% of studies. In multivariable analyses, patient- and study-level factors associated with M/R rating included: age <1 year (OR 1.90 [1.15-3.13]), truncus arteriosus (vs. tetralogy of Fallot, OR 2.55 [1.5-4.35]), and CCT (vs. CMR, OR 2.67 [1.87-3.83]). None of the provider- or center-level factors reached statistical significance in the multivariable model. CONCLUSIONS Most CMRs and CCTs ordered for the follow-up care of patients with conotruncal defects were rated appropriate. However, there was significant center-level variation in appropriateness ratings. Younger age, CCT, and truncus arteriosus were independently associated with higher odds of M/R rating. These findings could inform future quality improvement initiatives and further exploration of factors resulting in center-level variation.
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Affiliation(s)
- Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Sowmya Balasubramanian
- Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, AnnArbor, MI, USA
| | - Sujatha Buddhe
- Department of Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Kimberly Crum
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Grace Kong
- Department of Pediatrics, Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marc V Lee
- Nationwide Children's Hospital, The Heart Center, Columbus, OH, USA
| | - Leo Lopez
- Department of Pediatrics, Divison of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shobha S Natarajan
- Department of Pediatrics, Divison of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark D Norris
- Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, AnnArbor, MI, USA
| | - David A Parra
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anitha Parthiban
- Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Bryant Priromprintr
- Department of Pediatrics, Divison of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lindsay S Rogers
- Department of Pediatrics, Divison of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shagun Sachdeva
- Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sanket S Shah
- Department of Pediatrics, Divison of Pediatric Cardiology, Children's Mercy Kansas City, University of Missouri, Kansas City, MO, USA
| | - Clayton A Smith
- Pediatric Biostatistics Core, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Kenan W D Stern
- Department of Pediatrics, Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Yijin Xiang
- Pediatric Biostatistics Core, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Luciana T Young
- Department of Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
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25
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Lakshmanan S, Gimelli A. Cancer risk in adult congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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26
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Hee Kim K, Choo KS, Jin Nam K, Lee K, Hwang JY, Park C, Jung Yang W. Cardiac CTA image quality of adaptive statistical iterative reconstruction-V versus deep learning reconstruction "TrueFidelity" in children with congenital heart disease. Medicine (Baltimore) 2022; 101:e31169. [PMID: 36281124 PMCID: PMC9592454 DOI: 10.1097/md.0000000000031169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several recent studies have reported that deep learning reconstruction "TrueFidelity" (TF) improves computed tomography (CT) image quality. However, no study has compared adaptive statistical repeated reconstruction (ASIR-V) using TF in pediatric cardiac CT angiography (CTA) with a low peak kilovoltage. OBJECTIVE This study aimed to determine whether ASIR-V or TF CTA image quality is superior in children with congenital heart disease (CHD). MATERIALS AND METHODS Fifty children (median age, 2 months; interquartile range, 0-5 months; 28 men) with CHD who underwent CTA were enrolled between June and September 2020. Images were reconstructed using 2 ASIR-V blending factors (80% and 100% [AV-100]) and 3 TF settings (low, medium, and high [TF-H] strength levels). For the quantitative analyses, 3 objective image qualities (attenuation, noise, and signal-to-noise ratio [SNR]) were measured of the great vessels and heart chambers. The contrast-to-noise ratio (CNR) was also evaluated between the left ventricle and the dial wall. For the qualitative analyses, the degree of quantum mottle and blurring at the upper level to the first branch of the main pulmonary artery was assessed independently by 2 radiologists. RESULTS When the ASIR-V blending factor level and TF strength were higher, the noise was lower, and the SNR was higher. The image noise and SNR of TF-H were significantly lower and higher than those of AV-100 (P < .01), except for noise in the right atrium and left pulmonary artery and SNR of the right ventricle. Regarding CNR, TF-H was significantly better than AV-100 (P < .01). In addition, in the objective assessment of the degree of quantum mottle and blurring, TF-H had the best score among all examined image sets (P < .01). CONCLUSION TF-H is superior to AV-100 in terms of objective and subjective image quality. Consequently, TF-H was the best image set for cardiac CTA in children with CHD.
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Affiliation(s)
- Kun Hee Kim
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
- *Correspondence: Ki Seok Choo, Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-RI, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Korea (e-mail: )
| | - Kyoung Jin Nam
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Kyeyoung Lee
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - ChanKue Park
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Woo Jung Yang
- Barunmom Rehabilitation Medicine, Busanjin-gu, Busan, Korea
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27
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Goo HW. Contrast-Enhanced CT Protocol for the Fontan Pathway: Comparison Between 1- and 3-Minute Scan Delays. Pediatr Cardiol 2022; 43:1104-1113. [PMID: 35107628 DOI: 10.1007/s00246-022-02830-2] [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: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
Optimal enhancement of the Fontan pathway is crucial for the accurate CT evaluation. Current guidelines for contrast-enhanced CT protocols are rather inconsistent in scan delays and injection methods. This single-center, retrospective study was performed to compare objective measures of contrast enhancement between 1- and 3-min scan delays (41 and 36 patients, respectively) to determine a better contrast-enhanced CT protocols for evaluating the Fontan pathway. In both groups, a biphasic injection protocol, in which 50% diluted contrast agent (the amount of iodinated contrast agent: 2.0 mL/kg; the amount of saline: 2.0 mL/kg) was injected at the injection rate of 0.5‒2.5 mL/s for 50 s followed by a saline flush at the same injection rate (0.5‒2.5 mL/s), was used. The degree and heterogeneity of cardiovascular enhancement, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantitatively evaluated. The mean densities of all cardiovascular structures were significantly higher in the 1-min delay protocol than in the 3-min delay protocols (p < 0.001). Heterogeneous enhancement (normalized standard deviation > 0.70) in the Fontan pathway was significantly more frequent in the 1-min delay protocol (p < 0.001). No significant differences were found in image noise (p > 0.141) and the frequency showing suboptimal noise (p = 1.000) between the two protocols. SNR and CNR were significantly lower in the 3-min delay protocol (p < 0.001). Compared with the 1-min delay protocol, the 3-min delay protocol achieved more homogeneous enhancement in the Fontan pathway on CT but showed lower contrast enhancement, SNR, and, CNR, indicating the need for further improvement.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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29
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Kumar P, Bhatia M. Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies. Radiol Cardiothorac Imaging 2022; 4:e210089. [PMID: 35923747 PMCID: PMC9308465 DOI: 10.1148/ryct.210089] [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: 03/27/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
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Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT working group of the Italian Society of Pediatric Cardiology (SICP) and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) Part I. Radiol Med 2022; 127:788-802. [PMID: 35608758 PMCID: PMC9308607 DOI: 10.1007/s11547-022-01490-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. Nevertheless, correct execution and interpretation require in-depth knowledge of all technical and clinical aspects of CHD, a careful assessment of risks and benefits before each exam, proper imaging protocols to maximize diagnostic information, minimizing harm. This position paper, written by experts from the Working Group of the Italian Society of Pediatric Cardiology and from the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, is intended as a practical guide for applying CCT and CMR in children and adults with CHD, wishing to support Radiologists, Pediatricians, Cardiologists and Cardiac Surgeons in the multimodality diagnostic approach to these patients. The first part provides a review of the most relevant literature in the field, describes each modality's advantage and drawback, making considerations on the main applications, image quality, and safety issues. The second part focuses on clinical indications and appropriateness criteria for CMR and CCT, considering the level of CHD complexity, the clinical and logistic setting and the operator expertise.
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31
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Pop M. Reply to Nyman, U.; Aspelin, P. Regarding Iodixanol for Pediatric CTA. Comment on “Pop, M. Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation—Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320. Children 2021, 8, 949”. CHILDREN 2022; 9:children9050709. [PMID: 35626886 PMCID: PMC9140064 DOI: 10.3390/children9050709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
We greatly appreciate the letter by Nyman et al. [...]
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Affiliation(s)
- Marian Pop
- ME1 Department, “George Emil Palade” University of Medicine Pharmacy Sciences and Technology of Tirgu Mures, 540142 Tirgu Mures, Romania; ; Tel.: +40-749-260-920
- Radiology and Medical Imaging Department, Tirgu Mures Emergency Institute for Cardiovascular Diseases and Heart Transplant, 540136 Tirgu Mures, Romania
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32
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Cardiovascular Computed Tomography in Pediatric Congenital Heart Disease: A State of the Art Review. J Cardiovasc Comput Tomogr 2022; 16:467-482. [DOI: 10.1016/j.jcct.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
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Saleh M, Gendy D, Voges I, Nyktari E, Arzanauskaite M. Complex adult congenital heart disease on cross-sectional imaging: an introductory overview. Insights Imaging 2022; 13:78. [PMID: 35467233 PMCID: PMC9038985 DOI: 10.1186/s13244-022-01201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Congenital heart disease is the most common group of congenital pathology. Over the past few decades, advances in surgical treatment have resulted in a rising population of adult patients with repaired complex congenital heart disease. Although the quality of life has greatly improved, a significant proportion of morbidities encountered in clinical practice is now seen in adults rather than in children. These patients often have significant haemodynamic pathophysiology necessitating repeat intervention. CT and MRI are excellent imaging modalities, which help elucidate potential complications that may need urgent management. Although imaging should be performed in specialised centres, occasionally patients may present acutely to emergency departments in hospitals with little experience in managing potentially complex patients. The purpose of this article is to provide an introductory overview to the radiologist who may not be familiar with complex congenital heart disease in adult patients. This educational review has three main sections: (1) a brief overview of the post-operative anatomy and surgical management of the most common complex conditions followed by (2) a discussion on CT/MRI protocols and (3) a review of the various complications and their CT/MRI findings.
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Affiliation(s)
- Mahdi Saleh
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - David Gendy
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Eva Nyktari
- Cardiovascular MRI Unit, BIOIATRIKI SA (Biomedicine Group of Companies), Athens, Greece
| | - Monika Arzanauskaite
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
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Ramirez-Suarez KI, Tierradentro-García LO, Otero HJ, Rapp JB, White AM, Partington SL, Harris MA, Vatsky SA, Whitehead KK, Fogel MA, Biko DM. Optimizing neonatal cardiac imaging (magnetic resonance/computed tomography). Pediatr Radiol 2022; 52:661-675. [PMID: 34657169 DOI: 10.1007/s00247-021-05201-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Magnetic resonance imaging (MRI) and CT perform an important role in the evaluation of neonates with congenital heart disease (CHD) when echocardiography is not sufficient for surgical planning or postoperative follow-up. Cardiac MRI and cardiac CT have complementary applications in the evaluation of cardiovascular disease in neonates. This review focuses on the indications and technical aspects of these modalities and special considerations for imaging neonates with CHD.
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Affiliation(s)
- Karen I Ramirez-Suarez
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA, 19146, USA. .,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Luis Octavio Tierradentro-García
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA, 19146, USA.,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.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L Partington
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew A Harris
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Seth A Vatsky
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin K Whitehead
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
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Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part II. Eur Heart J Cardiovasc Imaging 2022; 23:e136-e161. [PMID: 35175348 PMCID: PMC8944330 DOI: 10.1093/ehjci/jeab292] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/12/2022] Open
Abstract
Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. In this article, emerging CT technologies and biomarkers, such as CT-derived fractional flow reserve, perfusion imaging, and pericoronary adipose tissue attenuation, are described. In addition, the role of cardiac CT in the evaluation of atherosclerotic plaque, cardiomyopathies, structural heart disease, and congenital heart disease is revised.
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Affiliation(s)
- Gianluca Pontone
- Corresponding author. Tel: +39 02 58002574; Fax: +39 02 58002231. E-mail:
| | | | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
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36
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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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37
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:e279-e289. [DOI: 10.1093/ehjci/jeac048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 11/14/2022] Open
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38
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Lakhani DA, Balar AB, Kim C. Prominent crista terminalis mimicking a right atrial mass: A case report and brief review of the literature. Radiol Case Rep 2021; 17:434-438. [PMID: 34917223 PMCID: PMC8666457 DOI: 10.1016/j.radcr.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
The crista terminalis is a normal anatomical structure, characterized by a smooth muscular ridge along the superior aspect of the right atrium. It is derived from resorption of the right valve of the sinus venosus and it divides the right atrium into smooth posteromedial and trabeculated anterolateral portions. Crista terminalis is not normally detected in the standard views of transthoracic echocardiogram and non-gated CT of the chest. In rare circumstances, the crista terminalis may be prominent and could lead to misdiagnosis as a malignant process, such as in our case. A comprehensive understanding of the crista terminalis anatomy, and its characteristic appearance on transthoracic echocardiogram, CT and PET/CT will minimize the risk of misdiagnosis and will avoid patient anxiety with more extensive examinations. Here, we present a case of a 78-year-old male with newly diagnosed high-grade invasive urinary bladder urothelial carcinoma. Pre-operative transthoracic echocardiogram reported as 2 cm right atrial mass concerning a metastasis lesion. Subsequent evaluation with MRI cardiac morphology confirmed the diagnosis of benign prominent crista terminalis, a normal anatomical structure.
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Xu J, Liu J, Guo N, Chen L, Song W, Guo D, Zhang Y, Fang Z. Performance of artificial intelligence-based coronary artery calcium scoring in non-gated chest CT. Eur J Radiol 2021; 145:110034. [PMID: 34837795 DOI: 10.1016/j.ejrad.2021.110034] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the risk category performance of artificial intelligence-based coronary artery calcium score (AI-CACS) software used in non-gated chest computed tomography (CT) on three types of CT machines, considering the manual method as the standard. METHODS A total of 901 patients who underwent both chest CT and electrocardiogram (ECG)-gated non-contrast-enhanced cardiac CT with the same equipment within a 3-month period were enrolled in the study. AI-CACS software was based on a deep learning algorithm and was trained on multi-vendor, multi-scanner, and multi-hospital anonymized data from the chest CT database. The AI-CACS was automatically obtained from chest CT data by the AI-CACS software, while the manual CACS was obtained from cardiac CT data by the manual method. The correlation of the AI-CACS and manual CACS, concordance rate and kappa value of the risk categories determined by the two methods were calculated. The chi-square test was used to evaluate the differences in risk categories among the three types of CT machines from different manufacturers. The risk category performance of the AI-CACS for dichotomous risk categories bounded by 0, 100 and 400 was assessed. RESULTS The correlation of the AI-CACS with the manual CACS was ρ = 0.893 (p < 0.001). The Bland-Altman plot (AI-CACS minus manual CACS) showed a mean difference of -27.2 and 95% limits of agreement of -290.0 to 235.6. The agreement of risk categories for the CACS was kappa (κ) = 0.679 (p < 0.001), and the concordance rate was 80.6%. The risk categories determined by the AI-CACS software on three types of CT machines were not significantly different (p = 0.7543). As dichotomous risk categories bounded by 0, 100 and 400, the accuracy, kappa value, and area under the curve of the AI-CACS were 88.6% vs. 92.9% vs. 97.9%, 0.77 vs. 0.77 vs. 0.83, and 0.885 vs. 0.964 vs. 0.981, respectively. CONCLUSIONS There was good correlation and agreement between the AI-CACS and manual CACS in terms of the risk category. It is feasible to obtain the CACS using AI software based on non-gated chest CT data in a short time without increasing the radiation dose or economic burden. The AI-CACS software algorithm has good clinical universality and can be applied to CT machines from different manufacturers.
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Affiliation(s)
- Jie Xu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Jia Liu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Ning Guo
- ShuKun (BeiJing) Technology Co., Ltd., Jinhui Bd, Qiyang Rd, 100000 Beijing, China
| | - Linli Chen
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Weixiang Song
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Dajing Guo
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China
| | - Yu Zhang
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China.
| | - Zheng Fang
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Rd, Yuzhong District, 400010 Chongqing, China.
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40
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Pop M. Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation-Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110949. [PMID: 34828662 PMCID: PMC8623802 DOI: 10.3390/children8110949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Computed tomography angiography (CTA) in infants is considered one of the most challenging radiological examinations due to difficulties in balancing start delay, contrast agent (CA) volume and flow in order to achieve optimal opacification of the large vessels. This study aimed to compare the contrast enhancement achieved by four CAs when taking into consideration CA injection parameters and patient characteristics. Methods: We performed a retrospective assessment of forty-eight consecutive cardiothoracic CTAs performed for aortic arch evaluation on children aged 0–1 year. All examinations were performed using the same 64-slice scanner and power injector using the bolus tracking technique. Axial 0.6 mm slices were used to measure large vessel enhancement using regions of interest at the level of the main pulmonary artery, ascending and descending aorta. The recorded variables included anthropometric measurements, CA type, flow rate, volume, and the average Hounsfield unit (HU) values of the blood pool. Descriptive statistics are presented as averages and standard deviations (SD) for normal distributed data or otherwise as medians and interquartile ranges (IQRs). Results: We found no statistically significant differences between age and anthropometric parameters when looking at different CAs. The median CA volume was 7 (IQR, 7–9) mL with the average flow rate of 0.94 (SD, 0.23) mL/s. Ascending aorta average HU values were 605.9 (SD, 177.23) for Iomeprol 350, 626 (SD, 183.83) for Ioversol 350, 530.83 (SD, 175.56) for Iopromide 370 and 354.91 (SD, 115.81) for Iodixanol 320. The difference in HU value for Iodixanol 320 compared to the other CAs was statistically significant. Similar differences were found for the other vascular structures. Conclusion: In CTA of infants suspected of aortic arch hypoplasia/coarctation, Iodixanol 320 provided up to 40% less enhancement of the great vessels when compared to Iomeprol 350, Ioversol 350 and Iopromide 370.
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Affiliation(s)
- Marian Pop
- ME1 Department, “George Emil Palade” University of Medicine Pharmacy Sciences and Technology of Tirgu Mures, 540142 Tirgu Mures, Romania; ; Tel.: +40-749-260-920
- Radiology and Medical Imaging Department, Tirgu Mures Emergency Institute for Cardiovascular Diseases and Heart Transplant, 540136 Tirgu Mures, Romania
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41
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Ezzeldin DA, Hafez MS, Mansour A. Multidetector computed tomography for patients with congenital heart disease: a multi-center registry from Africa and Middle East; patients' characteristics and procedural safety. Egypt Heart J 2021; 73:90. [PMID: 34655343 PMCID: PMC8520552 DOI: 10.1186/s43044-021-00217-x] [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: 07/08/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background We aimed to establish a clinical registry for patients with congenital heart disease who referred to multidetector computed tomography in our country, to describe the pattern and clinical profile of such patients and document the safety and efficacy of the procedure in our daily practice. Results A total 2310 studies were analyzed after excluding studies with missed, and lost data. Half of our study population—1215 patients—52.5% were males. The median age of the patients was 12 months (IQR 37 months), and the youngest patient was 3 days old. The eldest patient was 50 years old. 68.27% of the patients were less than 2 years old, and two-third of the whole studied population 66.7% had cyanotic heart disease. Minor local access complications, complications related to anesthetic drugs, and allergic reactions were the most commonly encountered complications, with only single mortality mainly due to multiple associated multisystem congenital malformation. Conclusions Most of our patients with congenital heart disease referred for MDCT study were infants and young children. The majority of them had complex cyanotic heart disease. The study is safe, with excellent diagnostic yield and safe with very low incidence of complications.
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Affiliation(s)
- Dina Adel Ezzeldin
- Cardiology Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya Square, Next to Alnour Mosque, Cairo, 11591, Egypt.
| | - Mohamed Saber Hafez
- Cardiology Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya Square, Next to Alnour Mosque, Cairo, 11591, Egypt
| | - Amr Mansour
- Cardiology Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya Square, Next to Alnour Mosque, Cairo, 11591, Egypt
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Steele JM, Moore RA, Lang SM. Use of advanced cardiac imaging in congenital heart disease: growth, indications and innovations. Curr Opin Pediatr 2021; 33:495-502. [PMID: 34374664 DOI: 10.1097/mop.0000000000001051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Significant improvements in the diagnosis and management of patients with congenital heart disease (CHD) have led to improved survival. These patients require life-long noninvasive evaluation. The use of advanced imaging such as cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT) has increased to support this need. The purpose of this review is to discuss the basics of advanced cardiac imaging, indications and review the recent innovations. RECENT FINDINGS Recent literature has demonstrated the increasing reliance of advanced imaging for CHD patients. In addition, research is focusing on CMR techniques to shorten scan time and address previous limitations that made imaging younger and sicker patients more challenging. CCT research has involved demonstrating high-quality images with low radiation exposure. Advances in digital technology have impacted the interactivity of 3D imaging through the use of virtual and augmented reality platforms. With the increased reliance of advanced imaging, appropriate use criteria have been developed to address possible under or over utilization. SUMMARY The utilization of advanced cardiac imaging continues to increase. As CMR and CCT continue to grow, increased knowledge of these modalities and their usage will be necessary for clinicians caring for CHD patients.
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Affiliation(s)
- Jeremy M Steele
- Department of Pediatrics, Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Ryan A Moore
- Heart Institute, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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New-generation multidetector computed tomography technology for the management of congenital heart disease in children: Now we can! Rev Port Cardiol 2021; 40:591-593. [PMID: 34392903 DOI: 10.1016/j.repce.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Celi S, Gasparotti E, Capellini K, Vignali E, Fanni BM, Ali LA, Cantinotti M, Murzi M, Berti S, Santoro G, Positano V. 3D Printing in Modern Cardiology. Curr Pharm Des 2021; 27:1918-1930. [PMID: 32568014 DOI: 10.2174/1381612826666200622132440] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND 3D printing represents an emerging technology in the field of cardiovascular medicine. 3D printing can help to perform a better analysis of complex anatomies to optimize intervention planning. METHODS A systematic review was performed to illustrate the 3D printing technology and to describe the workflow to obtain 3D printed models from patient-specific images. Examples from our laboratory of the benefit of 3D printing in planning interventions were also reported. RESULTS 3D printing technique is reliable when applied to high-quality 3D image data (CTA, CMR, 3D echography), but it still needs the involvement of expert operators for image segmentation and mesh refinement. 3D printed models could be useful in interventional planning, although prospective studies with comprehensive and clinically meaningful endpoints are required to demonstrate the clinical utility. CONCLUSION 3D printing can be used to improve anatomy understanding and surgical planning.
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Affiliation(s)
- Simona Celi
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Katia Capellini
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Benigno M Fanni
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Lamia A Ali
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
| | | | - Michele Murzi
- Adult Cardiosurgery Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Sergio Berti
- Adult Interventional Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
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António M. New-generation multidetector computed tomography technology for the management of congenital heart disease in children: Now we can! Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cardiac computed tomography angiography in the pre-operative assessment of congenital heart disease in Thailand. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:92-99. [PMID: 34386050 PMCID: PMC8340641 DOI: 10.5114/kitp.2021.107470] [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: 01/13/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Cardiac computed tomography angiography (CCTA) plays a vital role in clinical practice in evaluating patients with congenital heart disease (CHD) when the information from echocardiography is equivocal. Aim To test the hypothesis that CCTA has significantly value for pre-operative evaluation of congenital heart disease and practicality in the diagnosis and management of congenital heart disease patients at our tertiary care academic hospital. Material and methods We studied a total of 78 congenital heart disease patients (median age: 4.5 years) who had undergone CCTA during the period January 2017 to October 2018 at our tertiary care academic hospital. Results The results were classified as diagnostic categories, and the impact of the procedure on strategizing management was analysed. In each group, the CCTA offered an advantage and provided specific clues for surgical or interventional management. In total, the sensitivity (97.5%), specificity (100%), positive predictive value (100%), negative predictive value (99.38%), and accuracy (99.5%) of CCTA, for which the significant findings were confirmed by surgical or cardiac catheterization, were excellent, with average exposure per CCTA study calculated at 1.41 (0.36–3.28) mSv. Conclusions CCTA is an excellent non-invasive modality for the evaluation of congenital heart disease patients, with an important diagnostic and decision-aiding role.
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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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Choi AD, Thomas DM, Lee J, Abbara S, Cury RC, Leipsic JA, Maroules C, Nagpal P, Steigner ML, Wang DD, Williams MC, Zeb I, Villines TC, Blankstein R. 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography: A Statement from the Society of Cardiovascular Computed Tomography. Radiol Cardiothorac Imaging 2021; 3:e200480. [PMID: 33778658 PMCID: PMC7978013 DOI: 10.1148/ryct.2020200480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Cardiovascular computed tomography (CCT) is a well-validated noninvasive imaging tool with an ever-expanding array of applications beyond the assessment of coronary artery disease. These include the evaluation of structural heart diseases, congenital heart diseases, peri-procedural electrophysiology applications, and the functional evaluation of ischemia. This breadth requires a robust and diverse training curriculum to ensure graduates of CCT training programs meet minimum competency standards for independent CCT interpretation. This statement from the Society of Cardiovascular Computed Tomography aims to supplement existing societal training guidelines by providing a curriculum and competency framework to inform the development of a comprehensive, integrated training experience for cardiology and radiology trainees in CCT. This article is being published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, and JACC: Cardiovascular Imaging. © 2020 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.
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Kumar P, Bhatia M. Role of Computed Tomography in Postoperative Follow-up of Arterial Switch Operation. J Cardiovasc Imaging 2021; 29:1-19. [PMID: 33511796 PMCID: PMC7847786 DOI: 10.4250/jcvi.2020.0106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
An arterial switch operation (ASO) is the standard treatment for infants and children born with D-loop transposition of the great arteries. During the ASO, the great vessels are transected from the native roots, switched and anastomosed with the opposite roots. This is accompanied by the relocation of the pulmonary artery anterior to the aorta by using the LeCompte maneuver and the translocation of coronary arteries to the neo-aorta. ASO has led to improved overall survival, and postoperative mortality is rare. Despite the improved outcomes, several postoperative sequelae may occur, and therefore patients require long-term follow-up. Computed tomography (CT) has emerged as a robust imaging modality in pre and postoperative evaluation of a variety of congenital heart disorders including ASO. Unlike echocardiography and cardiovascular magnetic resonance, CT is not hindered by a poor acoustic window, metallic devices or the need for sedation or general anesthesia. CT with advanced three-dimensional postprocessing techniques, high pitch scanning, wider detector system, electrocardiogram-dependent modulation and dose-reduction strategies is invaluable in assessing the postoperative complications after ASO.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India.
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India.,Cardiac Imaging, Cardiological Society of India, Kolkata, India.,International Regional Committee, India Chapter, Society of Cardiovascular Computed Tomography, Arlington, VA, USA
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