University Hospital Erlangen, Department of Radiology, Maximiliansplatz 1, 91054, Erlangen, Germany; Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schlossplatz 4, 91054, Erlangen, Germany.
University Hospital Erlangen, Department of Radiology, Maximiliansplatz 1, 91054, Erlangen, Germany; Imaging Science Institute Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
J Cardiovasc Comput Tomogr. 2019 Jul-Aug;13(4):226-233. doi: 10.1016/j.jcct.2019.01.023. Epub 2019 Feb 1.
Aim of this study was to assess the accuracy of ventricular septal defects (VSD) using high pitch computed tomography angiography (CTA) of the chest in children below 1 year of age, compared to the intraoperative findings and echocardiography.
Out of 154 patients that underwent Dual-Source CTA of the chest using a high-pitch protocol at low tube voltages (70-80 kV), 55 underwent surgical repair of a VSD (median age 8 days, range 1-348 days). The margins of the VSDs and their relation to the surrounding structures were reproduced by en-face views using multiplanar reformations (MPR). Absolute diameter, normalized area and relative area compared to the aortic valve annulus were used for discrimination between restrictive and non-restrictive defects. Localization was classified into four subtypes. The results were compared to two-dimensional echocardiography and intraoperative findings.
Median absolute size of VSDs did not differ significantly between CTA-measurements (10.8 mm, range 2.8-18.1 mm) and intraoperative findings (12.0 mm, 3.0-25.0 mm, p = 0.09). Echocardiographic values were significantly lower (9.6 mm, 3.0-18.5 mm, both p < 0.01). The classification of the location and orientation matched the intraoperative situs in 96.4% of all cases using CT and in 87.3% using echocardiography. Echocardiography missed the relation to valves in 11% of all cases. Pre-interventional sensitivity and specificity for detection of a VSD were 97.2/98.9% compared to echocardiography. Median radiation dose was 0.32 mSv (range 0.12-2.00 mSv) and differed significantly between second and third generation Dual-Source CT (0.43 vs. 0.22 mSv, p = 0.003).
Size and subtype of VSDs can be accurately assessed by CTA of the chest in patients with complex congenital heart defects at a very low radiation dose.
本研究旨在评估在 1 岁以下儿童中使用高心率胸部 CT 血管造影（CTA）诊断室间隔缺损（VSD）的准确性，并与术中发现和超声心动图进行比较。
在 154 例行双源 CTA 胸部检查的患者中，55 例行 VSD 修补术（中位年龄 8 天，范围 1-348 天）。使用多平面重建（MPR）制作 VSD 边缘及其与周围结构关系的正面视图。使用绝对直径、归一化面积和与主动脉瓣环的相对面积来区分限制型和非限制型缺损。定位分为四个亚型。将结果与二维超声心动图和术中发现进行比较。
CTA 测量的 VSD 大小（10.8mm，范围 2.8-18.1mm）与术中发现（12.0mm，3.0-25.0mm，p=0.09）无显著差异。超声心动图值明显较低（9.6mm，3.0-18.5mm，均 p<0.01）。使用 CT 时，所有病例中有 96.4%的病例定位和方向分类与术中相符，使用超声心动图时为 87.3%。超声心动图在所有病例中有 11%漏诊与瓣膜的关系。术前诊断 VSD 的敏感性和特异性分别为 97.2%/98.9%，与超声心动图相比。中位辐射剂量为 0.32mSv（范围 0.12-2.00mSv），第二代和第三代双源 CT 之间差异有统计学意义（0.43 与 0.22mSv，p=0.003）。
在辐射剂量非常低的情况下，高心率胸部 CTA 可准确评估复杂先天性心脏病患者 VSD 的大小和亚型。
