Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
J Cardiovasc Comput Tomogr. 2022 Jul-Aug;16(4):345-349. doi: 10.1016/j.jcct.2021.12.004. Epub 2021 Dec 17.
Advances in cardiac CT (CCT) scanner technology allow imaging without anesthesia, and with low radiation dose, making it an attractive technique in infants with congenital heart disease. However, the utility of CCT using a dual-source scanner with respect to diagnostic performance and impact on management has not been systematically studied in this population.
Retrospective review of infants who underwent CCT to determine the utility of CCT with respect to the following: answering the primary diagnostic question, providing new diagnostic information, prompting a change in management, and concordance with catheterization or surgical inspection.
A total of 156 infants underwent 172 scans at a median age of 64 days, (IQR 4-188) from Jan 2016-Dec 2019. The most frequent diagnostic question was related to the pulmonary arteries (43%), followed by the aortic arch (30%), pulmonary veins (26%), coronary arteries (17%), patent ductus arteriosus (10%) and others (9%). A high-pitch spiral scan was frequently used (90%). The median effective radiation dose was low (0.66 mSv) and general anesthesia was used infrequently (23%). CCT answered the primary diagnostic question in 168/172 (98%) and added to the diagnostic information already available by echocardiography in 161/172 (96%) scans. CCT led to a change in management following 78/172 (53%) scans and had an impact on management following 167/172 (97%) scans. On follow-up, after 107/172 (62%) scans, subjects underwent cardiac surgery, and after 55/172 (32%) scans, they had cardiac catheterization. CCT findings were concordant with catheterization and/or surgical inspection in 156/159 (98%) scans.
In infants with complex congenital heart disease, CCT was accurate, answered the diagnostic questions in nearly all cases, and frequently added diagnostic information that impacted management. Radiation exposure was low, and anesthesia was needed infrequently.
心脏 CT（CCT）扫描仪技术的进步使得在无需麻醉且辐射剂量较低的情况下进行成像成为可能，这使其成为患有先天性心脏病的婴儿的一种有吸引力的技术。然而，在该人群中，使用双源扫描仪进行 CCT 的诊断性能和对管理的影响尚未得到系统研究。
回顾性分析接受 CCT 的婴儿，以确定 CCT 在以下方面的用途：回答主要诊断问题、提供新的诊断信息、提示改变管理、以及与导管插入术或手术检查的一致性。
共有 156 名婴儿在 2016 年 1 月至 2019 年 12 月期间接受了 172 次扫描，中位年龄为 64 天（IQR 4-188）。最常见的诊断问题与肺动脉有关（43%），其次是主动脉弓（30%）、肺静脉（26%）、冠状动脉（17%）、动脉导管未闭（10%）和其他（9%）。高频螺旋扫描经常使用（90%）。中位有效辐射剂量较低（0.66 mSv），且很少使用全身麻醉（23%）。CCT 回答了 172 次扫描中的 168 次（98%）主要诊断问题，并在 172 次扫描中的 161 次（96%）中增加了超声心动图已有的诊断信息。CCT 导致 172 次扫描中的 78 次（53%）改变了管理，而 172 次扫描中的 167 次（97%）对管理有影响。在随访中，172 次扫描中的 107 次（62%）接受了心脏手术，而 172 次扫描中的 55 次（32%）接受了心脏导管插入术。CCT 结果与导管插入术和/或手术检查在 159 次中的 156 次（98%）中一致。
在患有复杂先天性心脏病的婴儿中，CCT 准确，几乎所有病例都回答了诊断问题，并经常提供影响管理的新诊断信息。辐射暴露较低，且很少需要全身麻醉。
