Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation-Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320

Advances in the Diagnosis and Management of Congenital Heart Disease in Children

The last five decades have witnessed an inordinate number of advances in the diagnosis and management of congenital heart defects (CHDs), as reviewed elsewhere [...].

Comparing the Diagnostic Performance of ECG Gated versus Non-Gated CT Angiography in Ascending Aortic Dissection: A GRRAS Study

Rationale and Objective: Thoracic CT angiography (CTA) for ascending aortic dissection, a life-threatening emergency, is performed routinely without Electrocardiographic (ECG) gating, therefore allowing the apparition of a pulsation artefact. We aimed to evaluate and compare the diagnostic performance, the inter and intra-reporter agreement of ECG gated CTA and non-ECG gated CTA for detecting ascending aortic dissection, considering their training level. Our hypothesis is that ECG gated CTA has superior diagnostic accuracy for ascending aortic dissection compared to non-gated CTA. Materials and Methods: We collected data using 24 questions survey using clinically validated CT examinations. Sixty-six respondents (medical students, radiology residents, and consultants) blinded to the actual diagnosis independently evaluated the images pertaining to the presence of ascending aortic dissection. The reference standard was represented by clinical and imaging diagnosis. Inter-rater and inter-group concordance was evaluated; the agreement with reference tests was calculated and assessed as a function of reporters’ training level. Results: Reporters’ ascending aortic dissection assessment showed a better correlation with the reference standard in the ECG gated CTA. The inter-rater correlation was higher in the ECG gated CTA compared to non-ECG gated CTA. Observers’ confidence for diagnosing ascending aortic dissection was higher in the ECG gated CTA. Statistically significant differences (p < 0.05) were found between different training levels when assessing non-ECG gated examinations. Conclusions: ECG gated CTA shows a higher diagnostic performance for ascending aortic dissection than non-ECG gated CTA, regardless of the reporters’ training level.

Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Furthermore, the prevalence of anomalous origin of a coronary artery is higher in patients with TOF than in the general population (6% vs. ≤1%). Preoperative assessment of cardiovascular anatomy using computed tomography (CT) angiography enables the adaptation of the surgical approach to avoid potentially overlooked anomalies. Our purpose was to determine the prevalence of coronary artery and aortic arch anomalies in a cohort of TOF patients. Methods: In this retrospective analysis, data were collected from CT reports (2015–2021) of 105 TOF patients. All images were acquired using a 64-slice multi-detector CT (MDCT) scanner. Results: The median age of the patients was 38.7 months, with a male-to-female ratio of 1.39. The overall prevalence of coronary artery anomalies (CAAs) was 7.61% (8 of 105 cases). The anomalous origin and course of coronary arteries across the right ventricular outflow tract (RVOT; prepulmonic course) were defined in 5.71% of cases (six patients). In four of these, the left anterior descending artery (LAD) originated from the right coronary artery (RCA), while in two cases, the RCA arose from the LAD. In the remaining two patients, the coronary arteries followed an interarterial course. The most frequent anomalous aortic arch pattern in the overall TOF population was the right aortic arch (RAA) with mirror image branching, seen in 20% of patients (21 cases). The most frequent anomaly of the supra-aortic trunks was bovine configuration, found in 17.14% (18 cases). Conclusions: The prevalence of CAAs and aortic arch anomalies detected by CT angiography was in line with the data reported in anatomical specimens. Therefore, this technique represents a powerful tool for the evaluation of congenital cardiovascular anomalies.

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”

We greatly appreciate the letter by Nyman et al. [...]