Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center, CHU Montpellier, France (J.L.R., M.V., H.A., K.L., P.A.).
PHYMEDEXP, University of Montpellier, CNRS, INSERM, CHU Montpellier, France (J.L.R., M.V., A.L., P.A.).
Circ Cardiovasc Imaging. 2019 Feb;12(2):e008348. doi: 10.1161/CIRCIMAGING.118.008348.
The use of coronary computed tomography (CT) angiography in children with coronary artery anomalies is increasing. However, it remains technically demanding and the need to adapt acquisition parameters to a patient's cardiac characteristics has not yet been addressed. The aim of the study was to prospectively assess the feasibility of personalized multiphasic coronary CT angiography for pediatric patients.
Fifty pediatric patients (mean age 6.1±4.9 years) with coronary artery anomalies underwent a coronary CT angiography on a wide detector single-source CT equipment. Fifteen different acquisition patterns were used to trigger the acquisition at the best theoretical moment within the cardiac cycle. The appropriate pattern was automatically selected based on the patient's heart rate and heart rate variability, derived from the patient's ECG. Two independent radiologists qualitatively evaluated images.
All acquisitions fully answered the clinical question for a mean effective dose of 0.97±0.34 mSv. Image quality qualified as good or excellent in 94% of cases (47/50). No examination was considered as not assessable but 6% (3/50) were scored as adequate for diagnosis. For these 3 patients, motion artifacts were the main cause of average image quality. No significant visual differences were reported between the different coronary arteries (mean score of 3.6 on a 4-point scale). No correlation between image quality and cardiac parameters were reported ( r=-0.19 and r=0.00, respectively for heart rate and heart rate variability).
Personalized multiphasic coronary CT angiography acquisitions could be performed with diagnostic quality for a dose equivalent of <4 months of natural background irradiation.
URL: https://www.clinicaltrials.gov . Unique identifier: NCT03194763.
冠状动脉 CT 血管造影（CTA）在冠状动脉畸形儿童中的应用正在增加。然而，其技术仍然具有挑战性，且尚未解决针对患者心脏特征调整采集参数的问题。本研究旨在前瞻性评估针对儿科患者的个体化多期冠状动脉 CT 血管造影的可行性。
50 例冠状动脉畸形的儿科患者（平均年龄 6.1±4.9 岁）在一台宽探测器单源 CT 设备上进行冠状动脉 CTA。使用 15 种不同的采集模式在心动周期的最佳理论时刻触发采集。根据患者的心率和心率变异性（源自患者心电图），自动选择合适的模式。两位独立的放射科医生对图像进行定性评估。
所有采集均在平均有效剂量为 0.97±0.34 mSv 的情况下充分回答了临床问题。94%（47/50）的病例图像质量评为良好或优秀。没有检查被认为无法评估，但 6%（3/50）的诊断足够。对于这 3 例患者，运动伪影是导致平均图像质量不佳的主要原因。不同冠状动脉之间没有明显的视觉差异（4 分制平均评分为 3.6）。未报告图像质量与心脏参数之间存在相关性（心率和心率变异性的相关系数分别为-0.19 和 0.00）。
可以使用具有诊断质量的个体化多期冠状动脉 CTA 采集，剂量相当于 4 个月以下的自然背景辐射。
网址：https://www.clinicaltrials.gov 。唯一标识符：NCT03194763。
