Application of Dual-Source-Computed Tomography in Pediatric Cardiology in Children Within the First Year of Life

Abstract

Purpose: To assess fields of application and value of dual source computed tomography (DSCT) for diagnostics and therapy in patients with congenital heart disease during their first year of life. Evaluation of image quality, surgical use and radiation exposure of 2nd and 3 rd generation DSCT.

Materials and methods: DSCT was applied in 118 cases between January 2012 and October 2014 for diagnostics of congenital heart defects. 2nd generation was used in 91 cases until April 2014 and 3 rd generation in 27 cases during the period thereafter. 3 D reconstructions of the image data were created for clinical diagnostics and planning of interventions. Image quality was assessed using a 4-point-scale. The visibility of the mammary arteries was analyzed, and signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. The usefulness of 3D-reconstructions for surgical planning was rated using a 5-point-scale. Radiation exposure and contrast dye consumption were determined. All cases were analyzed retrospectively.

Results: DSCT was successfully used in 118 cases. All image data obtained were interpretable. More than 60 percent of cases did not show any artifacts. The mammary arteries were visible down to the diaphragmatic arch in more than 80 percent of cases. Diagnostic value and surgical benefit were evaluated as “useful” or as “essential” in all cases. Median radiation dose was 0.4 mSv and 0.27 mSv for the 2nd and 3 rd generation DSCT, respectively. Consumption of contrast dye was 2 ml/kg in all cases.

Conclusion: DSCT is a modern and extremely helpful technique for diagnostics and planning of interventions in patients with complex congenital heart defects. Extracardiac vascular structures in particular can be depicted three-dimensionally at high resolution. The use of iterative reconstruction with 3 rd generation DSCT yielded image quality similar to that of 2nd generation DSCT at considerably reduced radiation exposure level compared to 2nd generation DSCT. 3 rd generation DSCT is a low risk, accurate and extremely fast technique for diagnosing unstable patients with CHD.

Key points:

• Expanded scope of indications for DSCT in diagnosing critically ill infants

• Effective radiation dose is considerably lower than 0.5 mSv

• Extremely rapid image acquisitions with high image quality

• Possibility of optimized 3D-based surgical planning

Citation Format:

• Hausmann P, Stenger A, Dittrich S et al. Application of Dual-Source-Computed Tomography in Pediatric Cardiology in Children Within the First Year of Life. Fortschr Röntgenstr 2016; 188: 179 – 187

Zusammenfassung

Ziel: Evaluation von Einsatzmöglichkeiten und Nutzen der Dual-Source-Computertomografie (DSCT) bei Säuglingen mit angeborenem Herzfehler (AHF). Bewertung von Bildqualität, chirurgischen Stellenwert und Strahlenbelastung der 2. und 3. Generation DSCT.

Material und Methoden: Die DSCT wurde zwischen 2012 und 2014 in 118 Fällen zur Diagnostik AHF angewendet. Bis April 2014 wurde die 2. Generation DSCT in 91 Fällen und die 3. Generation im darauffolgenden Zeitraum in 27 Fällen durchgeführt. Die gewonnenen Bilddaten wurden zur Diagnostik und Eingriffsplanung dreidimensional (3 D) aufbereitet. Zur Evaluation der Bildqualität wurde eine 4-Punkte-Skala verwendet. Die Visualisierung der A. mammaria, das Signal-Rausch-Verhältnis (SNR) sowie das Kontrast-Rausch-Verhältnis (CNR) wurden ausgewertet. Der chirurgische Nutzen der DSCT wurde anhand einer 5-Punkte-Skala beurteilt. Die Strahlendosis und der Kontrastmittelverbrauch wurden bestimmt.

Ergebnisse: Alle gewonnenen Bilddaten waren interpretierbar. In über 60 % der Fälle waren die Bilddaten artefaktfrei. Die A. mammaria war in über 80 % der Fälle mindestens bis zur Zwerchfellkuppel darstellbar. Die diagnostische Wertigkeit und der chirurgische Nutzen wurden immer als „nützlich“ oder „essenziell“ bezeichnet. Die Strahlenbelastung betrug bei der 2. Generation im Median 0,4 mSv und bei der 3. Generation 0,27 mSv. Der Kontrastmittelverbrauch war stets 2 ml/kg.

Schlussfolgerung: Die DSCT ist ein modernes, überaus hilfreiches Verfahren zur Diagnostik und Eingriffsplanung bei Patienten mit komplexen AHF. Insbesondere extrakardiale, vaskuläre Strukturen lassen sich in hoher Auflösung 3 D darstellen. Durch die iterative Rekonstruktion der Daten in der 3. Generation DSCT kann bei erheblich geringerer Strahlenbelastung im Vergleich zur 2. Generation DSCT eine gleich gute Bildqualität erzielt werden. Die 3. Generation DSCT ist damit ein schonendes, exaktes und extrem schnelles Verfahren zur Diagnostik instabiler kardiologischer Patienten.

Key words

heart - CT-angiography - surgery

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