Abstract
PurposeTo evaluate the feasibility and diagnostic accuracy of retrospective electrocardiographically (ECG)-gated dual-source computed tomography (DSCT) for the assessment of double outlet right ventricle (DORV) and associated multiple malformations in pediatric patients.Materials and MethodsForty-seven patients <10 years of age with DORV underwent retrospective ECG-gated DSCT. The location of the ventricular septal defect (VSD), alignment of the two great arteries, and associated malformations were assessed. The feasibility of retrospective ECG-gated DSCT in pediatric patients was assessed, the image quality of DSCT and the agreement of the diagnosis of associated malformations between DSCT and transthoracic echocardiography (TTE) were evaluated, the diagnostic accuracies of DSCT and TTE were referred to surgical results, and the effective doses were calculated.ResultsApart from DORV, 109 associated malformations were confirmed postoperatively. There was excellent agreement (κ = 0.90) for the diagnosis of associated malformations between DSCT and TTE. However, DSCT was superior to TTE in demonstrating paracardiac anomalies (sensitivity, coronary artery anomalies: 100% vs. 80.00%, anomalies of great vessels: 100% vs. 88.57%, separate thoracic and abdominal anomalies: 100% vs. 76.92%, respectively). Combined with TTE, DSCT can achieve excellent diagnostic performance in intracardiac anomalies (sensitivity, 91.30% vs. 100%). The mean image quality score was 3.70 ± 0.46 (κ = 0.76). The estimated mean effective dose was < 1 mSv (0.88 ± 0.34 mSv).ConclusionsRetrospective ECG-gated DSCT is a better diagnostic tool than TTE for pediatric patients with complex congenital heart disease such as DORV. Combined with TTE, it may reduce or even obviate the use of invasive cardiac catheterization, and thus expose the patients to a much lower radiation dose.
Highlights
Double outlet right ventricle (DORV) is a complex congenital heart disease that occurs via embryological ventriculoarterial discordance such that the two great arteries completely or predominately arise (>50%) from the right ventricle [1]
dual-source computed tomography (DSCT) was superior to transthoracic echocardiography (TTE) in demonstrating paracardiac anomalies
Combined with TTE, DSCT can achieve excellent diagnostic performance in intracardiac anomalies
Summary
Double outlet right ventricle (DORV) is a complex congenital heart disease that occurs via embryological ventriculoarterial discordance such that the two great arteries completely or predominately arise (>50%) from the right ventricle [1]. Digital subtraction angiography is considered to be the gold standard initial imaging modality for application in cases of pediatric patients with DORV. It is an invasive procedure that carries risks associated with catheter-related complications. Another inevitable issue is its high radiation dose [2]. Transthoracic echocardiography (TTE) has been regarded as the first-line imaging modality for pediatric patients with DORV. Some pediatric patients, those with claustrophobia, are not suited for this examination because of the long acquisition time. The need for high spatial resolution and elimination of motion artifacts to achieve optimal diagnostic image quality remains a current challenge [3]
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