Value of MDCT as a non- invasive modality in evaluation of pediatric congenital cardiovascular anomalies

Abstract

Objective: Assessing the role of MSCT compared to TTE in pediatric patients with congenital heart diseases especially the thoracic congenital vascular anomalies. Methods: 54 pediatric patients underwent a 128 detectors computed tomography cardiac angiography with retrospective ECG-gating. Images were reviewed based on segmental approach using the operative data (35/54 patients) or cardiac catheterization (19/54 patients) findings as reference standard. Sensitivity, specificity, positive and negative predictive values and accuracy of TTE and MDCT were evaluated. Results: MDCT was superior to TTE in evaluating vascular lesions (aortic, conotruncal, coronary artery, major aorto-pulmonary collaterals, patent ductus arteriosus, venous anomalies and postoperative complications) as well as pulmonary lesions; while TTE was superior in intracardiac anomalies with equal performance in (pulmonary artery anomalies, concordance and valvular atresia). MDCT achieved (100%, 96.3% and 87%) accuracies compared to TTE (94.4%, 85.2% & 96.3%) for delineating isolated vascular anomalies, complex vascular anomalies and intracardiac anomalies respectively. Conclusion: The main added value of cardiac MDCT to TTE is the precise illustration of the extracardiac anatomic structures, without adding significant information on intracardiac abnormalities. Using MDCT with TTE has improved the diagnostic accuracy thus obviating the need for diagnostic cardiac catheterization especially in critically ill patients.

Keywords

• Congenital heart diseases
• CCTA
• Pediatric