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Efficacy and safety of coronary computed tomography angiography in diagnosing coronary lesions in children

Published online by Cambridge University Press:  25 October 2023

Sharon W. Gould Open the ORCID record for Sharon W. Gould [Opens in a new window] ,
M. Patricia Harty ,
Mark Cartoski ,
Vijay Krishnan ,
Nicole Givler ,
John Ostrowski  and
Takeshi Tsuda
Sharon W. Gould*
Affiliation:
Radiology Department, Nemours Children’s Health Delaware Valley, Wilmington, DE, USA
M. Patricia Harty
Affiliation:
Radiology Department, Nemours Children’s Health Delaware Valley, Wilmington, DE, USA
Mark Cartoski
Affiliation:
Nemours Cardiac Center, Nemours Children’s Health Delaware Valley, Wilmington, DE, USA
Vijay Krishnan
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
Nicole Givler
Affiliation:
Radiology Department, Nemours Children’s Health Delaware Valley, Wilmington, DE, USA
John Ostrowski
Affiliation:
Nemours Cardiac Center, Nemours Children’s Health Delaware Valley, Wilmington, DE, USA
Takeshi Tsuda
Affiliation:
Nemours Cardiac Center, Nemours Children’s Health Delaware Valley, Wilmington, DE, USA
*
Corresponding author: S. W. Gould; Email: sharon.gould@nemours.org
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Abstract

Introduction:

Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children.

Materials:

Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability.

Results:

Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval.

Conclusions:

Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient’s body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.

Keywords

PediatriccoronaryCTCT angiographyradiationdose reduction
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 4 , April 2024 , pp. 838 - 845
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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