Accuracy, Image Quality, and Radiation Dose of Prospectively ECG-Triggered High-Pitch Dual-Source CT Angiography in Infants and Children with Complex Coarctation of the Aorta

Abstract

To evaluate the diagnostic accuracy, image quality, and radiation dose of prospective electrocardiogram (ECG)-triggered high-pitch dual-source computed tomography (DSCT) in infants and young children with complex coarctation of the aorta (CoA). Forty pediatric patients aged < 4 years with suspected CoA underwent prospective ECG-triggered high-pitch DSCT angiography and transthoracic echocardiography (TTE). Surgery and/or conventional cardiac angiography (CCA) were performed in all patients. The diagnostic accuracy of DSCT angiography and TTE was compared to the surgical and/or CCA findings. The causes of misdiagnosis and miss were analyzed, and the advantages and limitation of both imaging modalities were evaluated. Image quality of DSCT was evaluated, and effective radiation dose was calculated. The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of DSCT in evaluation of complex CoA were 92.37%, 98.51%, 97.32%, 93.57%, and 96.25%, respectively. There was a significant difference in the accuracy between DSCT and TTE (χ² = 9.9, P＜.05). For a total of 80 extracardiac anomalies, the sensitivity (98.8%, 79/80) of DSCT was greater than that of TTE (62.5%; 50 of 80). On the contrary, for 38 cardiac anomalies, the sensitivity (78.9%, 30 of 38) of DSCT was lesser than that of TTE (100%; 38 of 38). The mean score of image quality was 4.27 ± 0.73. The mean effective radiation dose was 0.20 ± 0.09 mSv. Prospective ECG-triggered high-pitch DSCT may be a clinical feasible modality in the evaluation of pediatric patients with complex CoA, providing adequate image quality, high diagnostic accuracy, and low radiation dose.