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Assessment of in-stent stenosis in small children with congenital heart disease using multi-detector computed
Joachim G Eichhorn1, Frederick R Long, Sharon L Hill
1Department of Radiology, Ohio State University College of Medicine, Columbus, USA. joachim_eichhorn@med.uni-heidelberg.de
Insights
Multi-detector computed tomography (MDCT) reliably assesses in-stent stenosis in children with congenital heart disease (CHD). This imaging method accurately detects stent complications, aiding precise intervention planning and follow-up assessments.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Limited data exists on multi-detector computed tomography (MDCT) feasibility for assessing stents in pediatric congenital heart disease (CHD).
- Stent placement is crucial for treating CHD in children, necessitating reliable imaging for evaluation.
Purpose of the Study:
- To evaluate the diagnostic reliability of MDCT in assessing in-stent stenosis compared to digital angiography (DA) in young children.
- To determine MDCT's accuracy in identifying stent-related complications in pediatric CHD patients.
Main Methods:
- Twenty-two children with 42 transcatheter stents underwent both MDCT and digital angiography (DA).
- Stent and minimal luminal diameters were measured by independent observers to assess interobserver variability and correlation.
- Sensitivity and specificity of MDCT for detecting stenosis were calculated against DA as the gold standard.
Main Results:
- MDCT and DA allowed measurement of 93% of stent segments with low interobserver variability (r=0.97).
- MDCT demonstrated high correlation with DA for percent stenosis (r=0.89) and excellent specificity (97%) for detecting stenosis.
- MDCT accurately diagnosed all stent-associated complications, including fractures and narrowings, with sensitivity exceeding 98% for >=20% stenosis.
Conclusions:
- MDCT is a feasible and promising imaging modality for evaluating stent complications in pediatric CHD.
- Cardiac surgeons and interventional cardiologists can utilize MDCT for precise intervention planning and follow-up assessment in children.
Objectives:
Our purpose was to investigate the diagnostic reliability of multi-detector computed tomography (MDCT) in assessing in-stent stenosis compared to digital angiography (DA) in small children.
Background:
Little is known about the feasibility of using MDCT to assess stents placed to treat children with congenital heart disease (CHD).
Methods:
Twenty-two children (median age [range], 2(3/4) [(1/2) to 12] years) with 42 transcatheter placed stents (median diameter: 7.2 [3.4-16.3] mm) in the pulmonary arteries (n = 36), aorta (2), PDA (1), and SVC (3) underwent both MDCT and DA due to suspected hemodynamic problems.
Results:
Independent "blinded" observers were able to measure stent and minimal luminal diameters in 115 out of 124 (93%) stent segments on MDCT and DA. The interobserver variability was low (mean difference: 0.5, SD 0.8 mm) with high correlation (r = 0.97; P < .0001). The percent stenosis by MDCT correlated well with DA (r = 0.89, P < .0001; mean error 2.7, SD 10.4%). For all grades of stenosis, the sensitivity and specificity for MDCT were 58% and 97%, respectively. At a threshold of approximately > or =20% stenosis sensitivity became >98%. All stent associated complications [fracture (4), vascular narrowings (11)] were diagnosed by MDCT. As the stent diameter increased, there was significantly reduced variability between MDCT and DA for in-stent stenosis (P < .0001).
Conclusion:
In small children, MDCT is a feasible and promising method for assessing stent associated complications in the treatment of CHD. Cardiac surgeons and interventional cardiologists might rely on this imaging modality to plan specific interventions more precisely and to assess the results upon follow up.
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