Utility of cardiac CT in infants with congenital heart disease: Diagnostic performance and impact on management

Photon-counting computed tomography for paediatric congenital heart defects yields images of high diagnostic quality with low radiation doses at both 70 kV and 90 kV

BACKGROUND

Photon-counting computed tomography (PCCT) is a new clinical method that may show better diagnostic quality at lower radiation doses than conventional CT.

OBJECTIVE

To investigate the diagnostic quality and radiation dose of paediatric cardiovascular PCCT for diagnosis of congenital heart defects at 70 kV and 90 kV.

MATERIALS AND METHODS

This retrospective assessment included clinical non-gated paediatric PCCT examinations for assessment of congenital heart defects. Radiation doses were recorded, and overall and specific diagnostic quality (1-4) were scored by four paediatric radiologists. Agreement, differences, and trends were assessed by percent rater agreement, intraclass correlation, Mann-Whitney tests, and Jonckheere-Terpstra tests.

RESULTS

Seventy children with congenital heart defects were examined at 70 kV (n = 35; age 2 days-16 years; 63% boys) or 90 kV (n = 35; age 2 days-17 years; 51% boys). All observers gave a median score of 4 (high diagnostic quality) for both 70 kV and 90 kV, with no difference in median values between tube voltages (all P > 0.06). Agreement for overall scores was 66-94% for 70 kV and 60-77% for 90 kV. Agreement for specific scores was 80-97% for 70 kV and 83-89% for 90 kV. Size-dependent dose estimate was 0.68 mGy (0.25-2.02 mGy) for 70 kV and 1.10 mGy (0.58-2.71 mGy; P < 0.001) for 90 kV. Effective dose was 0.30 mSv (0.15-0.82 mSv) for 70 kV and 0.39 mSv (0.22-1.51 mSv; P = 0.01) for 90 kV.

CONCLUSION

Paediatric cardiovascular PCCT yields images for congenital heart defects of high diagnostic quality with low radiation dose at both 70 kV and 90 kV.

Trends in cardiac CT utilization for patients with pediatric and congenital heart disease: A multicenter survey study

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.

Photon-counting versus Dual-Source CT of Congenital Heart Defects in Neonates and Infants: Initial Experience

Background Photon-counting CT (PCCT) has been shown to improve cardiovascular CT imaging in adults. Data in neonates, infants, and young children under the age of 3 years are missing. Purpose To compare image quality and radiation dose of ultrahigh-pitch PCCT with that of ultrahigh-pitch dual-source CT (DSCT) in children suspected of having congenital heart defects. Materials and Methods This is a prospective analysis of existing clinical CT studies in children suspected of having congenital heart defects who underwent contrast-enhanced PCCT or DSCT in the heart and thoracic aorta between January 2019 and October 2022. CT dose index and dose-length product were used to calculate effective radiation dose. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated by standardized region-of-interest analysis. SNR and CNR dose ratios were calculated. Visual image quality was assessed by four independent readers on a five-point scale: 5, excellent or absent; 4, good or minimal; 3, moderate; 2, limited or substantial; and 1, poor or massive. Results Contrast-enhanced PCCT (n = 30) or DSCT (n = 84) was performed in 113 children (55 female and 58 male participants; median age, 66 days [IQR, 15-270]; median height, 56 cm [IQR, 52-67]; and median weight, 4.5 kg [IQR, 3.4-7.1]). A diagnostic image quality score of at least 3 was obtained in 29 of 30 (97%) with PCCT versus 65 of 84 (77%) with DSCT. Mean overall image quality ratings were higher for PCCT versus DSCT (4.17 vs 3.16, respectively; P < .001). SNR and CNR were higher for PCCT versus DSCT with SNR (46.3 ± 16.3 vs 29.9 ± 15.3, respectively; P = .007) and CNR (62.0 ± 50.3 vs 37.2 ± 20.8, respectively; P = .001). Mean effective radiation doses were similar for PCCT and DSCT (0.50 mSv vs 0.52 mSv; P = .47). Conclusion At a similar radiation dose, PCCT offers a higher SNR and CNR and thus better cardiovascular imaging quality than DSCT in children suspected of having cardiac heart defects. © RSNA, 2023.

Giant pulmonary artery aneurysm in a child: Rare complication of congenital heart disease

Key Clinical Message

This case report aims to increase awareness that pulmonary artery aneurysms may occur as a complication of neglected patent ductus arteriosus and should be sought in children with ill-treated congenital heart diseases.

Abstract

Pulmonary artery aneurysm is a rare anomaly with an autopsy prevalence of 1:14,000. These aneurysms can arise secondary to various etiologies, with congenital causes identified in 25% of cases and congenital heart diseases (CHD) responsible for more than half of these cases. A 12-year-old boy with CHD in the form of patent ductus arteriosus (PDA) and irregular clinical follow-up presented with new onset fatigue of 3 months duration. A physical examination revealed anterior chest wall bulging and a continuous murmur. A chest radiograph showed a smooth left hilar region opacity that has a close relation with the left cardiac border. Transthoracic echocardiogram shows no progression from the previous one; there was a large PDA and pulmonary hypertension, but no further information was available. Computed tomography angiography revealed a giant aneurysm of the main pulmonary artery (PA), with a maximum diameter of 8.6 cm, and dilatation of its branches of 3.4 and 2.9 cm for the right and left PA, respectively.

The journal of cardiovascular computed tomography: A year in review: 2022

This review aims to summarize key articles published in the Journal of Cardiovascular Computed Tomography (JCCT) in 2022, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor continues to grow. The articles selected by the Editorial Board of the JCCT in this review highlight the role of cardiovascular computed tomography (CCT) to detect subclinical atherosclerosis, assess the functional relevance of stenoses, and plan invasive coronary and valve procedures. A section is dedicated to CCT in infants and other patients with congenital heart disease, in women, and to the importance of training in CT. In addition, we highlight key consensus documents and guidelines published in JCCT last year. The Journal values the tremendous work by authors, reviewers, and editors to accomplish these contributions.