The value of dual-source multidetector-row computed tomography in determining pulmonary blood supply in patients with pulmonary atresia with ventricular septal defect
Abstract
Background: Primary evaluation of patients with pulmonary atresia with ventricular septal defect (PA-VSD) traditionally relies upon echocardiography and conventional cardiac angiography (CCA). Cardiac angiography is considered the gold standard for delineation of anatomy in children with PA-VSD. Data comparing CCA and dual-source multidetector-row computed tomography angiography (MDCT) in PA-VSD patients is limited. The objective of this study was to test the hypothesis that MDCT is equivalent to CCA for anatomic delineation in these patients.
Materials and methods: Twenty-eight patients with PA-VSD underwent CCA and MDCT in close proximity to each other without interval therapy. A retrospective review of these 28 patients was performed. All MDCT data of pulmonary artery morphology, major aortopulmonary collateral arteries (MAPCAs) and type of blood supply (dual vs. single supply) were evaluated by blinded experts and results were compared with CCA.
Results: Twenty-eight patients had adequate size right and left pulmonary arteries (21 confluent and 7 non-confluent). Seven patients had complete absence of native pulmonary artery and 3 patients had stenosis of distal branches of pulmonary arteries; all had MAPCAs from descending thoracic aorta and/or subclavian arteries. Sensitivity, specificity, positive and negative predictive value of MDCT for detecting confluent of pulmonary arteries, absence of native pulmonary artery and stenosis of pulmonary arteries were all 100%. Moreover, accuracy of detecting MAPCAs was excellent.
Conclusions: These results suggest that MDCT and CCA are equivalent in their ability to delineate pulmonary artery anatomy and MAPCAs. Dual source MDCT provides high diagnostic accuracy in evaluation of pulmonary blood supply in patients with PA-VSD and allows precise characterisation of the condition of pulmonary arteries and MAPCAs which is of paramount importance in managing patients with PA-VSD. (Folia Morphol 2018; 77, 1: 116–122)
Keywords: dual source multidetector row computed tomographypulmonary atresia with ventricular septal defectcardiac imaging
References
- Acherman RJ, Smallhorn JF, Freedom RM. Echocardiographic assessment of pulmonary blood supply in patients with pulmonary atresia and ventricular septal defect. J Am Coll Cardiol. 1996; 28(5): 1308–1313.
- Bean MJ, Pannu H, Fishman EK. Three-dimensional computed tomographic imaging of complex congenital cardiovascular abnormalities. J Comput Assist Tomogr. 2005; 29(6): 721–724.
- Brown SC, Eyskens B, Mertens L, et al. Percutaneous treatment of stenosed major aortopulmonary collaterals with balloon dilatation and stenting: what can be achieved? Heart. 1998; 79(1): 24–28.
- Cademartiri F, Nieman K, van der Lugt A, et al. Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology. 2004; 233(3): 817–823.
- Diethelm E, Soto B, Nath PH, et al. The pulmonary vascularity in patients with pulmonary atresia and ventricular septal defect. RadioGraphics. 1985; 5(2): 243–254.
- Ellis K. The bronchial arteries and anomalous ystemic arteries to the lungs in congenital heart and lung disease. In: Butler J. The bronchial circulation. Marcel Dekker, New York, NY 1992: 599–748.
- Flohr TG, Stierstorfer K, Ulzheimer H, et al. Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot. Med Phys. 2005; 32: 2536–2547.
- Goo HW, Park IS, Ko JK, et al. CT of congenital heart disease: normal anatomy and typical pathologic conditions. Radiographics. 2003; 23 Spec No: S147–S165.
- Greil GF, Kuettner A, Schoebinger M, et al. Visualization of peripheral pulmonary artery stenosis using high-resolution multidetector computed tomography. Vasc Med. 2005; 10(3): 235–236.
- Greil GF, Schoebinger M, Kuettner A, et al. Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT. Pediatr Radiol. 2006; 36(6): 502–509.
- Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Ventricular septal defect with pulmonary stenosis or atresia. In: (eds) Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results and indications. 3rd edition. Elsevier, Philadelphia 2003: 946–1073.
- Le Bret E, Macé L, Dervanian P, et al. Images in cardiovascular medicine. Combined angiography and three-dimensional computed tomography for assessing systemic-to-pulmonary collaterals in pulmonary atresia with ventricular septal defect. Circulation. 1998; 98(25): 2930–2931.
- Lee T, Tsai IC, Fu YC, et al. Using multidetector-row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility. Pediatr Radiol. 2006; 36(12): 1273–1282.
- Mackie AS, Gauvreau K, Perry SB, et al. Echocardiographic predictors of aortopulmonary collaterals in infants with tetralogy of fallot and pulmonary atresia. J Am Coll Cardiol. 2003; 41(5): 852–857.
- Maeda E, Akahane M, Kato N, et al. Assessment of major aortopulmonary collateral arteries with multidetector-row computed tomography. Radiat Med. 2006; 24(5): 378–383.
- Murai S, Hamada S, Yamamoto S, et al. Evaluation of major aortopulmonary collateral arteries (MAPCAs) using three-dimensional CT angiography: two case reports. Radiat Med. 2004; 22(3): 186–189.
- O’Leary PW, Edwards WD, Julsrud PR, Puga FJ. Pulmonary atresia and ventricular septal defect. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF. Moss and Adam’s heart disease in infants, children, and adolescents. Lippincott Williams & Wilkins, Baltimore, MD 2008: 878–88.
- Oguz B, Haliloglu M, Karcaaltincaba M. Paediatric multidetector CT angiography: spectrum of congenital thoracic vascular anomalies. Br J Radiol. 2007; 80(953): 376–383.
- Reddy VM, McElhinney DB, Amin Z, et al. Early and intermediate outcomes after repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries: experience with 85 patients. Circulation. 2000; 101(15): 1826–1832.
- Ropers U, Ropers D, Pflederer T, et al. Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol. 2007; 50(25): 2393–2398.
- Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC 2010 Appropriate Use Criteria for Cardiac Computed Tomography: a report of the American College of Cardiology/ Foundation Appropriate Use Criteria Task Force Society of Cardiovascular Computed Tomography/American College of Radiology/ American Heart Association/ American Society of Echocardiography/ American Society of Nuclear Cardiology/ Society for Cardiovascular Angiography and Interventions/ Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010; 56(22): 1864–1894.
- Tchervenkov CI, Roy N. Congenital Heart Surgery Nomenclature and Database Project: pulmonary atresia - ventricular septal defect. Ann Thorac Surg. 2000; 69(4 Suppl): S97–105.
