Application of Prospective ECG-Gated High-Pitch 128-Slice Dual-Source CT Angiography in the Diagnosis of Congenital Extracardiac Vascular Anomalies in Infants and Children

Pei Nie,Anbiao Wang,Wenjian Xu,Ximing Wang,Xiaopeng Ji,Ting Cao,Haiou Li,Yanhua Duan,Guangjie Yang,Xuejun Liu,Zhaoping Cheng,Elena Cavarretta

doi:10.1371/journal.pone.0115793

Abstract

PurposeTo investigate the value of prospective ECG-gated high-pitch 128-slice dual-source CT (DSCT) angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children in comparison with transthoracic echocardiography (TTE).MethodsEighty consecutive infants or children clinically diagnosed of congenital heart disease and suspected with extracardiac vascular anomaly were enrolled, and 75 patients were finally included in this prospective study. All patients underwent prospective ECG-gated high-pitch DSCT angiography after TTE with an interval of 1–7 days. The diagnostic accuracy and sensitivity of high-pitch DSCT angiography and TTE were compared according to the surgical/CCA findings. The image quality of DSCT was assessed using a five-point scale. The effective radiation dose (ED) was calculated.ResultsA total of 17 congenital heart diseases and 162 separate extracardiac vascular anomalies were confirmed by surgical/CCA findings in 75 patients. The diagnostic accuracy of high-pitch DSCT angiography and TTE was 99.67% and 97.89%, respectively. The sensitivity of high-pitch DSCT angiography and TTE was 97.53% and 79.62%, respectively. There was significant difference regarding to the diagnostic accuracy and the sensitivity between high-pitch DSCT angiography and TTE (χ2 = 23.561 and 28.013, P<0.05). The agreement on the image quality scoring of DSCT between the two observers was excellent (κ = 0.81), and the mean score of image quality was 4.1±0.7. The mean ED of DSCT was 0.29±0.08 mSv.ConclusionsProspective ECG-gated high-pitch 128-slice DSCT angiography with low radiation dose and high diagnostic accuracy has higher sensitivity compared to TTE in the detection of congenital extracardiac vascular anomalies in infants and children.

Highlights

Precise and comprehensive evaluation of the intracardiac and extracardiac deformities in congenital heart diseases (CHD) is critical for surgical plan
Taking surgical and/or cardiac angiography (CCA) findings as the reference standard, 2 bicuspid aortic valves (BAV) and 1 single coronary artery were not identified by high-pitch dual-source CT (DSCT) angiography
Our study demonstrates that prospective ECG-gated high-pitch 128-slice DSCT angiography shares high diagnostic accuracy and sensitivity in the assessment of congenital extracardiac vascular anomalies in children in comparison with Transthoracic echocardiography (TTE)

Summary

Introduction

Precise and comprehensive evaluation of the intracardiac and extracardiac deformities in congenital heart diseases (CHD) is critical for surgical plan. The value of MSCT in the evaluation of the thoracic vascular anomalies has been widely confirmed. As this imaging modality can provide cardiovascular information, and offer additional information about the airway and lung parenchyma, resulting in a greater anatomic coverage. A recent introduced dual-source CT (DSCT) system (Definition Flash, Siemens Healthcare, Forchheim, Germany) provides the high-pitch scan technique. In this high-pitch mode, data acquisition is prospectively triggered with the ECG. Non-overlapping spiral data acquisition, the radiation dose was reduced [8, 9]

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