Truncus arteriosus: Diagnosis with dual-source computed tomography angiography and low radiation dose

Pediatric Cardiovascular Computed Tomography: Clinical Indications, Technique, and Standardized Reporting. Recommendations From the Cardiothoracic Taskforce of the European Society of Pediatric Radiology

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.

Imaging of the Rare Association of Truncus Arteriosus in a Neonate with the Ductal Origin of the Left Subclavian Artery Using Multidetector CT Angiography and 3D Rendering

We present the unreported case of a rare association of truncus arteriosus with the ductal origin of the left subclavian artery. Understanding and preoperative identification of these aortic variations are essential to guide optimal surgical management. In this study, the role of advanced visualization 3D modeling techniques in imaging these complex anomalies is discussed.

Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications

The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.

Imaging of the spectrum of abnormal systemic arterial supply to the lungs using dual-source CT

Abnormal systemic arterial supply to the lungs can be seen in various congenital and acquired diseases. Identification and characterisation of aberrant vascular supply is essential for further management and treatment. Multidetector computed tomography (CT) with its multiplanar capabilities and volume-rendering techniques provides precise information regarding the anatomy and spatial relationship of arterial vascular channels. The following concise review elucidates the characteristic imaging findings of conditions in which systemic arteries are seen supplying the lung parenchyma on dual-source CT.

Electrocardiography-gated dual-source computed tomography in the detection of atrial septal aneurysm

The aim of the current study was to investigate the atrial septal aneurysm (ASA) incidence rate and describe its morphologic features by dual-source computed tomography (DSCT). A total of 8,626 patients (4,284 men and 4,342 women) who underwent DSCT examinations were enrolled. The presence of ASA was defined as the protrusion of the complete or partial interatrial septum with a maximum vertical distance (MVD) from the atrial septum plane of >10 mm during a cardiac cycle and a diameter of the aneurysm base of >15 mm. The MVD and direction of the protrusion, as well as other abnormalities, were recorded. The ASA patients were classified by both gender and directions of protrusion into four groups, including the right atrium (RA) and left atrium (LA) groups in males and females, respectively. Values across groups were compared using the independent-sample t-test and differences in qualitative variables were assessed with the χ² test. Of the 8,626 patients, 51 (0.6%) were diagnosed with ASA (mean age, 62±10 years), including 23 (0.5%) males and 28 (0.6%) females. There were no significant differences in the age (t=-1.37, P>0.05) and incidence rate (χ²=0.43, P>0.05) between the male and female groups. However, there were significant differences in the mean ages (t=-2.20, P<0.05) and the gender proportions (χ²=7.39, P<0.05) of patients in the RA and LA groups. In the two male groups, no significant differences were observed in the diameters of the ASA bases and MVD in the RA and LA groups. In the female groups, the differences in the MVD of protrusion in RA and LA groups were non-significant, whereas the diameters of the base of ASA demonstrated significant differences (t=2.27, P<0.05). In conclusion, the ASA incidence rate was 0.6%, and electrocardiography-gated DSCT scan served as an alternative diagnostic technique for the detection of ASA. It is essential for radiologists to recognize this clinical entity and to minimize misdiagnoses and missed diagnoses.

Case Report. Persistent Common Arterial Trunk in an Adult Presenting in the Emergency Room as Severely Decompensated Heart Failure

Truncus arteriosus (TA) or common arterial trunk is a rare malformation, accounting for 0.21 to 0.34% of congenital heart diseases, which, if left untreated, leads to increased mortality rates. The condition is characterized by the presence of a unique arterial trunk that overrides the interventricular septum. Despite an overall poor outcome, few subjects present in emergency settings with signs suggestive for pulmonary arterial hypoplasia and associated heart failure. We report the case of a 31-year-old female patient who had been previously diagnosed with pulmonary atresia and severe scoliosis as an infant, presenting in the emergency department with clinical sings of decompensated heart failure which were demonstrated to be attributable to the severe cyanogenic heart malformation and were reversible after initiation of appropriate therapeutic measures.

Application of intelligent optimal kV scanning technology (CARE kV) in dual-source computed tomography (DSCT) coronary angiography

This study aims to evaluate the applications and values of dual-source computed tomography (DSCT) intelligent optimal kV scanning technology (CARE kV) in coronary CT angiography (CCTA). 150 patients with normal body mass index were performed DSCT coronary angiography, then randomly divided into the "Semi", 120,100 and 80 kV Group, and the 2 "on" groups, with 30 patients in each group. The first 5 groups used the reference voltage as 120 kV, and the reference current as 400 mAs, while the other group used the reference voltage as 100 kV, and the reference current as 400 mAs. The image quality, average CT value, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and radiation dose were comparatively analyzed among the 5 groups. The image quality scores of the five groups showed no significant difference (P > 0.05); the average CT values and image noises had significance (P < 0.05), while SNR and CNR showed no significant difference (P > 0.05). The 80 kV group showed the biggest noise, with the CT value as 700 HU, while the radiation dose was the lowest, followed by the on group. As for the patients with normal body mass index (BMI), CARE kV-"on" could obtain high-quality images and lower radiation dose for CCTA, while the operation was simple and convenient.