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Gužvinec P, Muscogiuri G, Hrabak-Paar M. CT Assessment of Aortopulmonary Septal Defect: How to Approach It? J Clin Med 2024; 13:3513. [PMID: 38930042 PMCID: PMC11204932 DOI: 10.3390/jcm13123513] [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: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
An aortopulmonary septal defect or aortopulmonary window (APW) is a rare cardiovascular anomaly with direct communication between the ascending aorta and the main pulmonary artery leading to a left-to-right shunt. It is accompanied by other cardiovascular anomalies in approximately half of patients. In order to avoid irreversible sequelae, interventional or surgical treatment should be performed as soon as possible. Cardiovascular CT, as a fast, non-invasive technique with excellent spatial resolution, has an increasing role in the evaluation of patients with APW, enabling precise and detailed planning of surgical treatment of APW and associated anomalies if present. This article aims to review the anatomical and clinical features of aortopulmonary septal defect with special emphasis on its detection and characterization by a CT examination.
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Affiliation(s)
| | | | - Maja Hrabak-Paar
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- University Hospital Center Zagreb, 10000 Zagreb, Croatia
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Herrmann J, Ording-Müller LS, Franchi-Abella S, Verhagen MV, McGuirk SP, Dammann E, Bokkers RPH, Clapuyt PRM, Deganello A, Tandoi F, de Goyet JDV, Hebelka H, de Lange C, Lozach C, Marra P, Mirza D, Kalicinski P, Patsch JM, Perucca G, Tsiflikas I, Renz DM, Schweiger B, Spada M, Toso S, Viremouneix L, Woodley H, Fischer L, Petit P, Brinkert F. European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (1) pre-transplant evaluation. Pediatr Radiol 2024; 54:260-268. [PMID: 37985493 PMCID: PMC10830904 DOI: 10.1007/s00247-023-05797-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Liver transplantation is the state-of-the-art curative treatment in end-stage liver disease. Imaging is a key element for successful organ-transplantation to assist surgical planning. So far, only limited data regarding the best radiological approach to prepare children for liver transplantation is available. OBJECTIVES In an attempt to harmonize imaging surrounding pediatric liver transplantation, the European Society of Pediatric Radiology (ESPR) Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phase. This paper reports the responses on preoperative imaging. MATERIAL AND METHODS An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted and 22 institutions from 11 countries returned the survey. From 2018 to 2020, the participating centers collectively conducted 1,524 transplantations, with a median of 20 transplantations per center per annum (range, 8-60). RESULTS Most sites (64%) consider ultrasound their preferred modality to define anatomy and to plan surgery in children before liver transplantation, and additional cross-sectional imaging is only used to answer specific questions (computed tomography [CT], 90.9%; magnetic resonance imaging [MRI], 54.5%). One-third of centers (31.8%) rely primarily on CT for pre-transplant evaluation. Imaging protocols differed substantially regarding applied CT scan ranges, number of contrast phases (range 1-4 phases), and applied MRI techniques. CONCLUSION Diagnostic imaging is generally used in the work-up of children before liver transplantation. Substantial differences were noted regarding choice of modalities and protocols. We have identified starting points for future optimization and harmonization of the imaging approach to multicenter studies.
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Affiliation(s)
- Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitatsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | | | | | - Martijn V Verhagen
- Department of Radiology, University Medical Centre Groningen, Groningen, Netherlands
| | - Simon P McGuirk
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Elena Dammann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitatsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Reinoud P H Bokkers
- Department of Radiology, University Medical Centre Groningen, Groningen, Netherlands
| | | | | | - Francesco Tandoi
- Department of Hepatobiliary and Transplant Surgery, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | | | - Hanna Hebelka
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
| | - Charlotte de Lange
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Cecile Lozach
- Department of Radiology, Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Paolo Marra
- Department of Radiology, Azienda Ospedaliera Ospedali Riuniti Di Bergamo: Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Darius Mirza
- Department of Hepatobiliary and Transplant Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Piotr Kalicinski
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Janina M Patsch
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Giulia Perucca
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
- Department of Pediatric Radiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Ilias Tsiflikas
- Department of Radiology, University Clinic of Tübingen, Tübingen, Germany
| | - Diane M Renz
- Department of Pediatric Radiology, Hannover Medical School Hospital, Hannover, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Seema Toso
- Department of Pediatric Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Loïc Viremouneix
- Department of Radiology, Hôpital Femme Mère Enfant - Hospices Civils de Lyon, Bron, France
| | - Helen Woodley
- Department of Pediatric Radiology, Leeds Children's Hospital, Leeds, UK
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Petit
- Department of Pediatric Radiology, Hôpital de La Timone: Hopital de La Timone, Marseille, France
| | - Florian Brinkert
- Department of Pediatric Gastroenterology and Hepatology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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Cao J, Bache S, Schwartz FR, Frush D. Pediatric Applications of Photon-Counting Detector CT. AJR Am J Roentgenol 2023; 220:580-589. [PMID: 36287620 DOI: 10.2214/ajr.22.28391] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Photon-counting detector (PCD) CT represents the most recent generational advance in CT technology. PCD CT has the potential to reduce image noise, improve spatial resolution and contrast resolution, and provide multispectral capability, all of which may be achieved with an overall decrease in the radiation dose. These effects may be used to reduce the iodinated contrast media dose and potentially obtain multiphase images through a single-acquisition technique. The benefits of PCD CT have previously been shown primarily in phantoms and adult patients. This article describes the application of PCD CT in children, as illustrated by clinical examples from a commercially available PCD CT system.
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Affiliation(s)
- Joseph Cao
- Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705
| | - Steve Bache
- Department of Radiology, Clinical Imaging Physics Group, Duke University Medical Center, Durham, NC
| | | | - Donald Frush
- Department of Radiology, Division of Pediatric Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, NC
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Determination of Contrast Timing by Time-Resolved Magnetic Resonance Angiography in Patients With Bidirectional Glenn and Hemi-Fontan Anastomoses. J Comput Assist Tomogr 2022; 46:742-746. [PMID: 35617648 DOI: 10.1097/rct.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Children with single-ventricle congenital heart disease undergo a series of operations to maintain their pulmonary circulation including bidirectional Glenn (BDG) or hemi-Fontan in the second stage to create a superior cavopulmonary anastomosis. We aimed to optimize cardiovascular angiography protocols by determining optimal contrast timing of pulmonary and systemic circulation on magnetic resonance angiography (MRA) performed with the technique of time-resolved imaging with interleaved stochastic trajectories (TWIST). METHODS AND MATERIALS Cardiac TWIST MRA with lower extremity (LE) contrast injection was analyzed in 92 consecutive patients with a BDG or hemi-Fontan anastomosis. Contrast arrival time to inferior vena cava was set to zero to determine the relative time-to-peak (TTP) of the target vessels. Time-to-peak of each vessel was compared by age (<2 or ≥2 y), ejection fraction (<54% or ≥54%), the median values of heart rate (<111 or ≥111 beats per minute), body surface area (BSA, <0.59 or ≥0.59), cardiac index (<6.04 or ≥6.04), and indexed ascending aorta flow (AscAo_i, <5.3 or ≥5.3). The TTP of the vessels was also correlated with the volumetric parameters. RESULTS The mean age of 92 patients (32 female, 60 male) was 3.1 years (0.7-5.6 years). With LE injection, the first peak was depicted in AscAo. Time-to-peak of the pulmonary arteries was approximately 9 seconds later than AscAo. The TTP difference between pulmonary arteries and AscAo was shorter in high heart rate group (8.3 vs 10 seconds, P < 0.001). The TTP difference between AscAo and the mean of pulmonary arteries was significantly shorter in high cardiac index group (8.4 vs 9.9 seconds, P < 0.01) and high AscAo_i group (8.7 vs 9.7 seconds, P = 0.03). The TTP differences were not significant by age, ejection fraction, and BSA. Cardiac index and AscAo_i were negatively correlated with all TTPs except AscAo. The ejection fraction, stroke volume, and atrioventricular regurgitation fraction did not correlate with the TTP. CONCLUSIONS In patients with BDG or hemi-Fontan anastomosis, TTP of the pulmonary arteries on TWIST MRA via LE intravenous injection is approximately 9 seconds later than AscAo, approximately 8 and 10 seconds later in high and low heart rate groups, respectively. Cardiac index and AscAo_i have less effect on the TTP than the heart rate. There was no TTP difference of the pulmonary arteries by age, BSA, and ejection fraction and no correlation with ejection fraction, stroke volume, and atrioventricular regurgitation fraction. These data can be used to guide timing of pulmonary arterial enhancement of single-ventricle patients after BDG or hemi-Fontan anastomosis.
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Bae SB, Kang EJ, Choo KS, Lee J, Kim SH, Lim KJ, Kwon H. Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations. J Cardiovasc Imaging 2022; 30:231-262. [PMID: 36280266 PMCID: PMC9592245 DOI: 10.4250/jcvi.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022] Open
Abstract
There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.
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Affiliation(s)
- Sang Bin Bae
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Hyeon Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Kyoung Jae Lim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Heejin Kwon
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
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Fleury AS, Durand RE, Cahill AM, Zhu X, Meyers KE, Otero HJ. Validation of computed tomography angiography as a complementary test in the assessment of renal artery stenosis: a comparison with digital subtraction angiography. Pediatr Radiol 2021; 51:2507-2520. [PMID: 34374838 DOI: 10.1007/s00247-021-05145-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/27/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Renal artery stenosis is an important cause of hypertension in children, accounting for 5-10% of cases. When suspected, noninvasive imaging options include ultrasound (US), computed tomography (CT) angiography and magnetic resonance (MR) angiography. However, digital subtraction angiography (DSA) remains the gold standard. OBJECTIVE To investigate the accuracy and inter-reader reliability of CT angiography in children with suspected renal artery stenosis. MATERIALS AND METHODS This is a retrospective study of patients suspected of having renal artery stenosis evaluated by both CT angiography and DSA between 2008 and 2019 at a tertiary pediatric hospital. Only children who underwent CT angiography within 6 months before DSA were included. CT angiography studies were individually reviewed by two pediatric radiologists, blinded to clinical data, other studies and each other's evaluation, to determine the presence of stenosis at the main renal artery and 2nd- and 3rd-order branches. The sensitivity, specificity and accuracy were calculated using DSA as the reference. The effective radiation dose for CT angiography and DSA was also calculated. Kappa statistics were used to assess inter-reader agreement. RESULTS Seventy-four renal units were evaluated (18 girls, 19 boys). The patients' median age was 8 years (range: 1-21 years). Overall, CT angiography was effective in detecting renal artery stenosis with a sensitivity of 85.7%, specificity of 91.5% and accuracy of 88.9%. There was moderate inter-reader agreement at the main renal artery level (k=0.73) and almost perfect inter-reader agreement at the 2nd/3rd order (k=0.98). However, the sensitivity at the 2nd- and 3rd-order level was lower (14.3%). CT angiography provided excellent negative predictive value for evaluating renal artery stenosis at the main renal artery level (90.1%) and at the 2nd- or 3rd-order branches (82.7%). The median effective dose of CT angiography studies was 2.2 mSv (range: 0.6-6.3) while the effective dose of DSA was 13.7 mSv. CONCLUSION CT angiography has high sensitivity and specificity at the main renal artery level with a lower radiation dose than previously assumed. Therefore, it can be used as a diagnostic tool in patients with low to medium risk of renal artery stenosis, and as a screening and treatment planning tool in patients at high risk.
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Affiliation(s)
- Anilawan S Fleury
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Rachelle E Durand
- Department of Radiology and Biomedical Imaging, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Xiaowei Zhu
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Kevin E Meyers
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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