Contrast medium application in pediatric high-pitch cardiovascular CT angiography: Manual or power injection?

Saake, Marc; Lell, Michael; Rompel, Oliver; Gloeckler, Martin; May, Matthias; Eller, Achim; Achenbach, Stephan; Uder, Michael; Wuest, Wolfgang

doi:10.1016/j.jcct.2014.05.002

Cited by 11 publications

(4 citation statements)

References 27 publications

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“…Subjective image quality was defined as diagnostic when the scores were equal to or greater than 2 on the 3-point scale and equal to or greater than 3 on the 5-point scale. The assessment scale for image quality was based on a previous pediatric study using cardiovascular CT angiography [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction

et al. 2017

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BackgroundFull iterative reconstruction algorithm is available, but its diagnostic quality in pediatric cardiac CT is unknown.ObjectiveTo compare the imaging quality of two algorithms, full and hybrid iterative reconstruction, in pediatric cardiac CT.Materials and methodsWe included 49 children with congenital cardiac anomalies who underwent cardiac CT. We compared quality of images reconstructed using the two algorithms (full and hybrid iterative reconstruction) based on a 3-point scale for the delineation of the following anatomical structures: atrial septum, ventricular septum, right atrium, right ventricle, left atrium, left ventricle, main pulmonary artery, ascending aorta, aortic arch including the patent ductus arteriosus, descending aorta, right coronary artery and left main trunk. We evaluated beam-hardening artifacts from contrast-enhancement material using a 3-point scale, and we evaluated the overall image quality using a 5-point scale. We also compared image noise, signal-to-noise ratio and contrast-to-noise ratio between the algorithms.ResultsThe overall image quality was significantly higher with full iterative reconstruction than with hybrid iterative reconstruction (3.67±0.79 vs. 3.31±0.89, P=0.0072). The evaluation scores for most of the gross structures were higher with full iterative reconstruction than with hybrid iterative reconstruction. There was no significant difference between full and hybrid iterative reconstruction for the presence of beam-hardening artifacts. Image noise was significantly lower in full iterative reconstruction, while signal-to-noise ratio and contrast-to-noise ratio were significantly higher in full iterative reconstruction.ConclusionThe diagnostic quality was superior in images with cardiac CT reconstructed with electrocardiogram-gated full iterative reconstruction.

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Section: Methodsmentioning

confidence: 99%

Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction

et al. 2017

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“…Cardiac CTA is becoming more and more established and is widely recommended in the preoperative management of CHD after prior echocardiography as it offers a detailed noninvasive insight into the cardiac anatomy and extracardiac vasculature. Advances of new CT techniques, for example, high-pitch CTA, allow extremely short examination times and reduced radiation dose, and neonatal intubation anesthesia is no longer needed (10,11). A mild sedation by pediatric cardiologist or, as predominantly in our study, the use of the patients' postprandial sleep phase allows an examination without the presence of an anesthetist.…”

Section: Discussionmentioning

confidence: 89%

“…CT suffers from radiation exposure and the use of iodinecontaining contrast agent. However, new CT techniques enable high-quality and detailed presentation of cardiac anatomy, thoracic vasculature, and extracardiac structures even in children with extremely short examination times and reduced radiation dose (10,11).…”

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confidence: 99%

Cardiac CT in the Preoperative Diagnostics of Neonates with Congenital Heart Disease: Radiation Dose Optimization by Omitting Test Bolus or Bolus Tracking

et al. 2020

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Rationale and Objectives: Congenital heart diseases (CHD) belong to the leading causes of infant mortality worldwide. Prognostic improvements result from multimodal therapy strategies leading to an increased demand for noninvasive imaging. The aim of the study was to further optimize cardiac CT radiation dose by omitting the test bolus or bolus tracking scan, which can have a relevant share of radiation exposure, especially in neonates. Materials and Methods: This retrospective study included 25 neonates with CHD who received a CT angiography (CTA) from 2009 to 2018. The examinations were performed as a high-pitch CTA (pitch 3.4, 80 kV) with manual contrast administration (1.5 ml/kg body weight) and fixed scan delay depending on the respective heart defect. Diagnosis, adverse events, radiation dose parameters, objective (contrastto-noise ratio) and subjective (4-point Likert scale) image quality as well as diagnostic accuracy compared to intraoperative findings was assessed. Results: All examinations were diagnostically evaluable without adverse events. The median CT dose index volume (CTDI vol) was 0.50 mGy (range, 0.15À0.94), the median dose-length product was 8 mGy £ cm (range, 3À17). The estimation of the effective dose by Monte Carlo simulation revealed lower median dose levels 0.66 mSv (range, 0.25À1.40 mSv) than previously published in comparable groups. All examinations achieved a very good mean image quality score of 1.2 § 0.4 with only minimal image noise and mean contrast-to-noise ratio of 16.1 § 7.0. Diagnostic accuracy was 100 % as cardiac anatomy revealed no new diagnoses or significant differences in the subsequent cardiac surgery. Conclusion: Cardiac high-pitch CTA of neonates with CHD can be performed safely and dose-reducing without additional test bolus or bolus tracking scan. With very good image quality, it provides a detailed insight into the cardiac anatomy and thus enables a differentiated, noninvasive therapy planning.

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“…The recent development in CT techniques allows better temporal and spatial resolution of CHD exams with less exposure to radiation (12,13). The new generations of dual-source CT (DSCT) scanners allow data acquisition within a part of the cardiac cycle providing better temporal and submillimeter isotropic spatial resolution.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of lower-dose cardiac CT in evaluating young infants with non-coronary complex congenital heart disease on a 64-slice multidetector CT scanner

2022

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Background Redoable precise and non-invasive diagnostic imaging modality with the least radiation dose is essential for infants with congenital heart disease (CHD) . Purpose To investigate the accuracy and estimate the radiation dose of our cardiac computed tomography (CCT) protocol. Material and Methods A total of 82 infants with CHD underwent non-ECG-gated CCT without contrast timing scanning techniques and were retrospectively studied. The image quality and radiation dose were estimated. The radiation dose was compared statistically to virtual retrospective ECG-gated and prospective ECG-triggering scanning modes. The diagnostic accuracy was assessed assuming the surgical results as the diagnostic gold standard. Results Most exams showed a high quality with low radiation doses compared to previous studies. The mean effective dose (ED) was 0.39 ± 1.2, significantly lower than that of the virtual retrospective ECG-gated and prospective ECG-triggering scanning and lower than in previous studies. Our CCT protocol has achieved a diagnostic accuracy of 99.52% with a sensitivity of 94.83% and specificity of 99.91%. Conclusion Non-ECG-gated CCT without contrast timing techniques can detect the non-coronary cardiovascular defects of CHD in infants with an ultralow radiation dose and a high diagnostic accuracy.

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Contrast medium application in pediatric high-pitch cardiovascular CT angiography: Manual or power injection?

Cited by 11 publications

References 27 publications

Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction

Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction

Cardiac CT in the Preoperative Diagnostics of Neonates with Congenital Heart Disease: Radiation Dose Optimization by Omitting Test Bolus or Bolus Tracking

Diagnostic accuracy of lower-dose cardiac CT in evaluating young infants with non-coronary complex congenital heart disease on a 64-slice multidetector CT scanner

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