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Assessment of Double Outlet Right Ventricle Associated with Multiple Malformations in Pediatric Patients Using Retrospective ECG-Gated Dual-Source Computed Tomography.

Shi K, Yang ZG, Chen J, Zhang G, Xu HY, Guo YK - PLoS ONE (2015)

Bottom Line: 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.The estimated mean effective dose was < 1 mSv (0.88 ± 0.34 mSv).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.

ABSTRACT

Purpose: To 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 methods: Forty-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.

Results: Apart 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).

Conclusions: Retrospective 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.

No MeSH data available.


Related in: MedlinePlus

DORV with subaortic VSD in a male aged 9 months.(a) The aorta (Ao) was posterior and to the right of the main pulmonary artery (MPA) (the measured angle = 24°). (b) The VSD was situated below the aortic valve. (c) A ductus arteriosus (arrow) extended from the aortic arch to the MPA. LPA, left pulmonary artery; LV, left ventricle; RAA, right auricular appendage; RPA, right pulmonary artery; RV, right ventricle; PDA, Patent ductus arteriosus.
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pone.0130987.g001: DORV with subaortic VSD in a male aged 9 months.(a) The aorta (Ao) was posterior and to the right of the main pulmonary artery (MPA) (the measured angle = 24°). (b) The VSD was situated below the aortic valve. (c) A ductus arteriosus (arrow) extended from the aortic arch to the MPA. LPA, left pulmonary artery; LV, left ventricle; RAA, right auricular appendage; RPA, right pulmonary artery; RV, right ventricle; PDA, Patent ductus arteriosus.

Mentions: According to Lev et al., there are four types of VSD, depending on the location of VSD relative to the two arterial valves [9]. If VSD was close to the aortic valve with its superior border lower than the inferior border of the aortic valve, it was termed a subaortic VSD (Figs 1b and 2b). In a similar manner, if VSD was close to the pulmonary valve with its superior border lower than the inferior border of the pulmonary valve, it was termed a subpulmonary VSD (Fig 3b), and if VSD was under both the aortic and pulmonary valves with equal distance, it was termed a double-committed VSD (Fig 4b). In a subset of patients, the distance between VSD and the two arterial valves was greater than the diameter of the Ao, which was termed a noncommitted VSD (Fig 5b) [10, 11]. The alignment of the two great arteries was determined by an angle between two specific lines. One was delineated to connect the sternum and center of the thoracic vertebral body and the other connected the two great arteries [11]. The measured angle increased as the line between the two great arteries rotated clockwise. The above measurement was performed on the transverse view through pulmonary bifurcation. If the Ao was posterior and to the right of the main pulmonary artery (MPA), in other words, 0° ≤ the measured angle < 90°, it was termed the RP position (Fig 1a); if two great arteries were side-by-side, in other words, the measured angle was equal to 90° or 270°, it was termed the side-by-side position (Fig 4a); if the Ao was anterior and to the right of the MPA (90° < the measured angle ≤ 180°), it was termed the RA position (Figs 3a and 5a); if the Ao was anterior and to the left of the MPA (180° < the measured angle < 270°), it was termed the LA position (Fig 2a).


Assessment of Double Outlet Right Ventricle Associated with Multiple Malformations in Pediatric Patients Using Retrospective ECG-Gated Dual-Source Computed Tomography.

Shi K, Yang ZG, Chen J, Zhang G, Xu HY, Guo YK - PLoS ONE (2015)

DORV with subaortic VSD in a male aged 9 months.(a) The aorta (Ao) was posterior and to the right of the main pulmonary artery (MPA) (the measured angle = 24°). (b) The VSD was situated below the aortic valve. (c) A ductus arteriosus (arrow) extended from the aortic arch to the MPA. LPA, left pulmonary artery; LV, left ventricle; RAA, right auricular appendage; RPA, right pulmonary artery; RV, right ventricle; PDA, Patent ductus arteriosus.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4482600&req=5

pone.0130987.g001: DORV with subaortic VSD in a male aged 9 months.(a) The aorta (Ao) was posterior and to the right of the main pulmonary artery (MPA) (the measured angle = 24°). (b) The VSD was situated below the aortic valve. (c) A ductus arteriosus (arrow) extended from the aortic arch to the MPA. LPA, left pulmonary artery; LV, left ventricle; RAA, right auricular appendage; RPA, right pulmonary artery; RV, right ventricle; PDA, Patent ductus arteriosus.
Mentions: According to Lev et al., there are four types of VSD, depending on the location of VSD relative to the two arterial valves [9]. If VSD was close to the aortic valve with its superior border lower than the inferior border of the aortic valve, it was termed a subaortic VSD (Figs 1b and 2b). In a similar manner, if VSD was close to the pulmonary valve with its superior border lower than the inferior border of the pulmonary valve, it was termed a subpulmonary VSD (Fig 3b), and if VSD was under both the aortic and pulmonary valves with equal distance, it was termed a double-committed VSD (Fig 4b). In a subset of patients, the distance between VSD and the two arterial valves was greater than the diameter of the Ao, which was termed a noncommitted VSD (Fig 5b) [10, 11]. The alignment of the two great arteries was determined by an angle between two specific lines. One was delineated to connect the sternum and center of the thoracic vertebral body and the other connected the two great arteries [11]. The measured angle increased as the line between the two great arteries rotated clockwise. The above measurement was performed on the transverse view through pulmonary bifurcation. If the Ao was posterior and to the right of the main pulmonary artery (MPA), in other words, 0° ≤ the measured angle < 90°, it was termed the RP position (Fig 1a); if two great arteries were side-by-side, in other words, the measured angle was equal to 90° or 270°, it was termed the side-by-side position (Fig 4a); if the Ao was anterior and to the right of the MPA (90° < the measured angle ≤ 180°), it was termed the RA position (Figs 3a and 5a); if the Ao was anterior and to the left of the MPA (180° < the measured angle < 270°), it was termed the LA position (Fig 2a).

Bottom Line: 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.The estimated mean effective dose was < 1 mSv (0.88 ± 0.34 mSv).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.

ABSTRACT

Purpose: To 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 methods: Forty-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.

Results: Apart 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).

Conclusions: Retrospective 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.

No MeSH data available.


Related in: MedlinePlus