Use of 320-Detector Computed Tomographic Angiography for Infants and Young Children with Congenital Heart Disease

Abstract

Pediatric patients with complex congenital heart disease (CHD) face a lifetime of treatment with interventional therapeutic and palliative procedures. Echocardiography remains the mainstay for noninvasive imaging of congenital heart lesions. This often is supplemented with diagnostic cardiac catheterization for additional anatomic and physiologic characterization. However, recent technological improvements in computed tomography (CT) and magnetic resonance imaging (MRI) have led to an increased focus on the use of these techniques given their better safety profile. This study aimed to review the authors' experience with a 320-slice multidetector CT scanner in the evaluation of CHD in children. This retrospective case study investigated 22 infants and young children with a provisional diagnosis of CHD. Their anatomic evaluation was performed using a 320-slice Aquilon ONE CT scanner. Of these 22 patients, 14 were examined without cardiac gating. This was subsequently modified to a prospective gated, targeted protocol to decrease the radiation dose. The images were interpreted by an experienced radiologist and a pediatric cardiologist. Continuous variables were expressed as mean and standard deviation or range, and the two imaging protocols were compared. A comparison of exposure rates with those from other pediatric studies that had used the 64-slice CT angiography also was performed. For the first group of patients, with nongated CT examinations, the mean effective whole-body radiation dose was 1.8 ± 0.71 millisieverts (mSv) (range, 0.96-3.2 mSv). For the second group, the mean was 0.8 ± 0.39 mSv (range, 0.4-1.5 mSv). Although the radiation dose was reduced dramatically, clinicians must be vigilant about the cumulative risk of radiation exposure.

Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

“…The latest technologic advances (such as scanners with a high volume of coverage) have enabled sub-mSv doses with acquisitions lasting less than 1 s. These devices can scan the entire thorax without the need for sedation and can obtain volumetric high-resolution images, even in small children who are unable to follow breathing instructions. [6][7][8][9][10][11][12][13] The effective radiation doses are similar to those for previously reported acquisitions by scanners with high volumes of coverage. In the study performed by Bonelli-Sica and colleagues 6 using 256-slice MDCT (whether with ECG-gated or non-ECG-gated protocol) in pediatric patients with anomalous PV drainage, the overall effective radiation dose was 1.01 mSv (range, 0.13-6.43 mSv), and it was 0.78 mSv (range, 0.13-4.16) in patients younger than 1 year of age.…”

“…In another study-by Huang and associates, 8 performed by 256-slice MDCT with a prospectively ECG-gated protocol in infants with congenital heart disease-the effective radiation dose was 1.6 ± 0.3 mSv (range, 1.1-2.5 mSv). Al-Mousily and co-authors 11 reported that the effective radiation dose in their study, conducted with 320-slice MDCT in infants and young children with congenital heart disease, was 0.8 ± 0.39 mSv (range, 0.4-1.5 mSv).…”

“…Compared with first-generation computed tomographic (CT) scanners, multidetector CT scanners-with their high volume of coverage (≥128 slices/gantry rotation)-enable faster and more accurate evaluation of the cardiac and vascular anatomy, with lower radiation exposure. [6][7][8][9][10][11][12][13] In this study, we used high-pitch, dual-source 256-slice MDCTA to evaluate the anatomic features of TAPVC and associated cardiovascular anomalies in a pediatric population, and we report the radiation doses associated with these examinations.…”

A New Approach To Chest Pain in the Emergency Room: “Triple Rule-Out CT

“…Şu an hastanelerde en yaygın olarak 64 kesitler bulunmakla birlikte birkaç merkezde 256 ve 320 kesit BT'ler kullanıl-maya başlanmıştır. Veri kalitesi ve radyasyon oranları ile ilgili olumlu sonuçlar bildirilmektedir (6,7).…”

Ionizing Radiation in Medical Imaging and Efforts in Dose Optimization

“…This has the potential to reduce the dose considerably. It has been determined that axial volumetric scanning constitutes a dose saving of up to 55% (Kroft et al, 2010;Al-Mousily et al 2011).…”