Comparison of 128-Slice Low-Dose Prospective ECG-Gated CT Scanning and Trans-Thoracic Echocardiography for the Diagnosis of Complex Congenital Heart Disease

Abstract

ObjectiveTo compare prospective ECG-gated multi-slice computed tomography (MSCT) and trans-thoracic echocardiography (TTE) in the diagnosis of complex congenital heart disease (CHD).MethodsThis was a prospective study of consecutive patients with complex CHD (age <7 years) treated at a tertiary hospital between May 2013 and May 2015. All patients were imaged with TTE and prospective ECG-gated 128-slice spiral CT in the week before surgery. Effective radiation dose (ED) was calculated from volume CT dose index (CTDIvol) and dose length product (DLP). Image quality (5-point scale) was assessed independently by two radiologists. Using surgical findings as the reference, the diagnostic capabilities of MSCT and TTE were compared.ResultsThirty-five patients (19 males) aged 1.59±1.58 years (range, 3 days to 74 months) were included. CTDIvol, DLP and ED were 0.90±0.24 mGy, 12.9±4.7 mGy∙cm and 0.64±0.21 mSv (range, 0.358–1.196 mSv), respectively. Image quality score was 4.3±0.5, and all images met the diagnostic requirements. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing CHD were 97.2%, 99.8%, 99.0%, and 99.5%, respectively, for MSCT, and 90.6%, 99.8%, 99.0%, and 98.4%, respectively, for TTE. MSCT not only had a higher sensitivity than TTE overall (97.2% vs. 90.6%; P<0.05), but was much more sensitive for the diagnosis of extracardiac vascular abnormalities (92.0% vs. 68.0%; P<0.05).Conclusion128-slice low-dose prospective ECG-gated CT scanning has important clinical value in the diagnosis of complex CHD in children, complementing and extending the findings of TTE.

Role of Electrocardiogram-Gated Multidetector Computed Tomography in Diagnosis of Congenital Heart Disease

“…As regard the ASD, Echo detected 11 cases but MDCT detected only 9 cases of small ASD. In agreement with Bu et al (1) . who reported that one case of small atrial septal defect was missed by MDCT.…”

“…Regarding the cardiac abnormalities, we found good agreement between Echo and ECG gated MDCT as regard cardiac abnormalities with kappa value measuring 0.771.This is in agreement with Zhang et al who reported that the accuracy of MDCT in diagnosis of cardiac malformation ranging between 88.37%, and 97.69% (4) . Also in agreement with Bu et al who reported that the sensitivity of MDCT for the diagnosis of cardiac malformations was 98.2% (57/58), not significantly different from the value of 96.6% (56/58) for TTE (1) .…”

“…For aforementioned data, we can say that Echo and ECG gated MDCT have a complementary role in diagnosing the congenital cardiac anomalies while ECG gated MDCT is more valuable and reliable method of diagnosing the Extra cardiac great vessels congenital anomalies. This is in agreement with Bu et al (1) and Goo (14) who reported that echocardiography is considered the method of choice for diagnosing the vast majority of congenital cardiac defects, CT plays a complementary role by providing objective and precise morphologic and functional information and is advantageous for depicting extra-cardiac abnormalities thus helping in pre-operative planning assessment of CHD patients.…”

“…Congenital heart disease (CHD) is one of the most commonly occurring congenital anomaly, affecting 4-10/1000 live births (1) .It is a major cause of serious morbidity and mortality. It is usually defined as clinically significant structural heart disease present at birth (2) .The survival of CHD patients has also increased because of improvements in early diagnosis and treatment (3) .Catheter angiography was used for many years as the investigation of choice for diagnosing CHD, the risk of complications associated with its invasive nature and use of contrast medium led to it being superseded by newer, non-invasive modalities.…”

“…It is usually defined as clinically significant structural heart disease present at birth (2) .The survival of CHD patients has also increased because of improvements in early diagnosis and treatment (3) .Catheter angiography was used for many years as the investigation of choice for diagnosing CHD, the risk of complications associated with its invasive nature and use of contrast medium led to it being superseded by newer, non-invasive modalities. Echocardiography (ECHO), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) are the primary modalities used for noninvasive cardiac imaging in patients with CHD (1) .…”