Clin Res Cardiol 100, Suppl 1, April 2011

V1501 - Evaluation of complex congenital heart disease and associated complications in newborns, infants and small children using multi-detector CT - A 10-year-experience at 5 centers
 
J. Eichhorn1, M. Fischer1, C. Fink2, S. Ley3, J. P. Cheatham4, W. Helbing5, F. Long6, M. Gorenflo1
 
1Abteilung II Schwerpunkt Kinderkardiologie, Universitätskinderklinik Heidelberg, Heidelberg; 2Institut für Klinische Radiologie, Universitätsklinikum Mannheim, Mannheim; 3Radiologische Klinik, Abt. Radiodiagnostik, Universitätsklinikum Heidelberg, Heidelberg; 4Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA; 5Department of Pediatric Cardiology, Erasmus University Rotterdamm, Rotterdam, Niederlande; 6Pediatric Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA;
 
Introduction: Multi-detector CT with multiplanar and three-dimensional (3D) reconstruction has become an important first-line imaging tool in diagnosis of congenital vascular anomalies (VA) and airway diseases in children. Aim of the study was to assess the diagnostic value of CT for evaluation of VA and associated complications in newborns and infants at 5 centers in 3 countries.
Materials and Methods: 277 children (mean age: 7 ± 7 months, range: 6 hours to 24 months) were examed between 2000 and 2010. The diagnoses included: suspected in-stent stenosis after stent placement to treat vascular stenoses (n=72), pulmonary atresia (32) and stenosis (48), arterial rings/slings (30), aortic arch anomalies (21), bronchoscopy revealed stenosis (23), abnormal pulmonary venous return (17) and others (34). The exams were performed on varying scanners (4 up to 256 slices, collimation isotrope 0.4-1.25 mm; scan-time 2-20 s, usage of low dose protocols: 80-120 kVp, 60-80 mA) under controlled ventilation or free breathing, mostly without ECG-gating to minimize radiation exposure. The image quality was rated using a 5-point score. Image findings were correlated to ECHO, conventional catherizations, bronchoscopy, and intraoperativ findings. The effects of dose on image quality were also evaluated, retrospectively.
Results: High quality CT data were almost free of cardiac and respiratory motion. Images were scored for vascular contrast and for delineation of the tracheobronchial tree in >95% of all cases as excellent or good, showing a significant improving with increasing number of detectors. Significant differences between higher and lower radiation settings were not found. The radiation exposure was mostly less than 2 mSv (range 0.3-3.2). High radiation exposure settings did not improve image quality. VA morphology and topography in relation to adjacent structures, e.g. tracheal and esophageal compression caused by an arterial ring or sling, could be assessed exactly and allowed the final diagnosis. Even smallest vessels with a diameter of less than 1 mm (see fig.), could be identified and excel­lently visualized. 82 % (228/277) of all patients had benefited from CT: Catherizations was neither necessary to perform surgical or interventional planning nor to exclude a VA, or radiation doses and sedation time due to interventional procedures could be reduced markedly.
Conclusions: A 3D submillimeter evaluation of the heart and great vessels can be achieved routinely in a matter of seconds with little motion artifacts, without general anesthesia and with much less radiation exposure than previously thought. Nevertheless, the optimal radiation dose settings for performing cardiac CT in infants and pediatric patients are still being worked out. The use of CT may result in a net decrease in overall radiation decreasing the number of diagnostic cardiac catherizations. CT can now be regarded as the modality of choice as a minimally invasive, robust, and accurate technique for the diagnosis of complex VA even in the group of new­borns and infants. Its accuracy for detecting VA appears at least equivalent to catherizations while it is more accurate in delineating potential life-threatening complications. This advance should have the greatest impact in the smallest, youngest, and most critically ill children with congenital heart disease.

 

Fig.: Newborn (3 kg) with total anomalous pulmonary venous drainage to the portal vein (Volume rendering: veins < 1 mm).
 

Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y

http://www.abstractserver.de/dgk2011/ft/abstracts/V1501.htm