Flachdetektor-Computertomografie in der diagnostischen und interventionellen Kinderkardiologie

Zusammenfassung

Ziel: Evaluation der Einsatzmöglichkeiten der Flachdetektor-Computertomografie (FD-CT) bei der Katheterisierung von Patienten mit angeborenen Herzfehlern. Erstellen von Anwendungsprotokollen für unterschiedliche Fragestellungen anhand der erzielten Bildqualität in verschiedenen anatomischen Regionen.

Material und Methoden: Die FD-CT wurde zwischen Januar 2010 und April 2012 in 176 Fällen während der Herzkatheteruntersuchung verwendet. Zur Evaluation der Bildqualität wurde eine 5-Punkte-Likert-Skala (von „essenziell“ bis „irreführend“) verwendet. Alle Fälle wurden retrospektiv analysiert und es wurden Applikationsprotokolle zur Visualisierung der Aorta, Pulmonalarterien, Lungenvenen, Semilunarklappen, cavopulmonalen Anastomosen und systemvenöser Tunnel erstellt. Der Kontrastmittelverbrauch und die Strahlendosis wurden ausgewertet.

Ergebnisse: Im untersuchten Zeitraum wurde die FD-CT in 176 Fälle durchgeführt. Die Patienten hatten ein mittleres Alter von 7,0 Jahren (0,01 – 42,53 Jahre). Die klinische Wertigkeit der FD-CT übertraf in 96,6 % der Fälle die konventionelle Angiografie und wurde nie als „irreführend“ bewertet. Die FD-CT wurde in 3,4 % der Fälle als „essenziell“, in 77,3 % der Fälle als „sehr nützlich“, in 15,9 % der Fälle als „nützlich“ und in 3,4 % der Fälle als „nicht nützlich“ bewertet. Das mittlere Dosis-Flächen-Produkt war 99 µGym² (19,3 – 1276,6 µGym²). Die benötigte Kontrastmittelmenge 1,76 ml/kg (0,9 – 5 ml/kg). Applikationsprotokolle zur Visualisierung unterschiedlicher anatomischer Regionen werden dargestellt.

Schlussfolgerung: Die FD-CT ist ein neues und hilfreiches Verfahren bei der diagnostischen und interventionellen Katheterisierung von Patienten mit angeborenen Herzfehlen. Insbesondere extrakardiale vaskuläre Strukturen lassen sich in hoher Auflösung dreidimensional darstellen und dienen zur Diagnostik, chirurgischen Planung und zur 3D-Navigation bei Interventionen.

Abstract

Purpose: In this study the use of flat detector computed tomography (FD-CT) in the catheterization of patients with congenital heart disease was evaluated. Application reports were created for various issues based on the achieved image quality in diverse anatomical regions.

Materials and Methods: FD-CT was applied in 176 cases during catheterization between January 2010 and April 2012. A five-point Likert scale (“essential” to “misleading”) was used to evaluate image quality. All cases were analyzed retrospectively and application reports for the visualization of the aorta, pulmonary arteries, pulmonary veins, semilunar valves, cavopulmonary connections and atrial baffles were generated. Contrast dye consumption and radiation dose were evaluated.

Results: During the observation period FD-CT was applied in all 176 cases. The mean patient age was 7.0 years (0.01 – 42.53 years). The clinical value of FD-CT was rated superior to conventional angiography in 96.6 % of the cases and was never rated as “misleading”. FD-CT was rated “essential” in 3.4 % of all cases, “very useful” in 77.3 % of all cases, “useful” in 15.9 % of all cases and “not useful” in 3.4 % of all cases. The mean dose-area product was 99 µGym² (19.3 – 1276.6 µGym²), and the used contrast dye was 1.76 ml/kg (0.9 – 5 ml/kg). Application reports for the visualization of different anatomical regions are demonstrated.

Conclusion: FD-CT is a new and auxiliary procedure in diagnostic and interventional catheterization of patients with congenital heart disease. Particularly extracardiac structures can be displayed in three-dimensional high resolution and be used for diagnosis, surgical planning and 3 D navigation.

Key words

heart - vascular - image manipulation/reconstruction - interventional procedures

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