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Low dose dual-source CT angiography in infants with complex congenital heart disease: a randomized study
1Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing 100037, China.
Insights
Prospective ECG-triggering dual-source CT angiography significantly reduces radiation dose in infants with complex congenital heart disease (CHD) without compromising diagnostic image quality compared to retrospective scanning.
Area of Science:
- Medical Imaging
- Pediatric Cardiology
- Radiology
Background:
- Congenital heart disease (CHD) in infants often requires advanced imaging.
- Dual-source CT (DSCT) angiography is used for diagnosis, but radiation dose is a concern.
- ECG-triggering techniques aim to optimize dose and image quality.
Purpose of the Study:
- To compare radiation dose and image quality of prospective ECG-triggering DSCT angiography versus retrospective ECG-gated scanning in infants with complex CHD.
- To evaluate the diagnostic utility of prospective ECG-triggering DSCT in this population.
Main Methods:
- Ninety-six infants (<1 year) with complex CHD underwent DSCT angiography.
- Three protocols were used: retrospective ECG-gated, prospective ECG-triggering (380 ms window), and prospective ECG-triggering (200 ms window).
- Radiation dose (effective dose, ED) and image quality (signal-to-noise ratio, SNR; qualitative score) were assessed.
Main Results:
- Image quality scores and SNR were comparable across all three groups (p > 0.05).
- Prospective ECG-triggering protocols showed significantly lower effective radiation doses compared to the retrospective protocol (p < 0.001).
- The 200 ms prospective window yielded the lowest ED (0.39 mSv median).
Conclusions:
- Prospective ECG-triggering DSCT angiography offers a substantial reduction in radiation dose for infants with complex CHD.
- Diagnostic image quality is maintained, making it a valuable second-line tool.
- This technique enhances safety in pediatric cardiac imaging.
Objectives:
To investigate the radiation dose and image quality of prospective ECG-triggering dual-source CT angiography in infants with complex congenital heart disease (CHD) in comparison with retrospective ECG-gated scanning.
Methods:
Ninety-six infants less than 1 year old (60/36 male/female, age: 4.8 ± 2.7 months, weight: 5.8 ± 1.8 kg) with complex CHD were enrolled. Three image acquisition protocols were set: group 1: 80 kV, 100 mA, retrospective ECG-gated protocol; group 2: 80 kV, 100 mA, prospective ECG-triggering protocol with acquisition window of 380 ms; group 3: 80 kV, 100 mA, prospective ECG-triggering protocol with acquisition window of 200 ms. Patients were selected to any one of the protocols randomly. The signal-to-noise ratios (SNR) were calculated in the ascending aorta and the pulmonary artery trunk. Image quality was assessed by a five-point score. A score of <3 represents non-diagnostic. Effective radiation dose (ED) was calculated.
Results:
Image quality score of groups 1, 2 and 3 were 4.1 ± 0.4, 4.0 ± 0.6 and 4.2 ± 0.6 (p = 0.224). SNR of ascending aorta and pulmonary artery trunk among them had no statistical difference (all p>0.05). The average ED (median) of groups 1, 2 and 3 were 1.17 ± 0.07 mSv (1.25 mSv), 0.72 ± 0.24 mSv (0.78 mSv) and 0.48 ± 0.41 mSv (0.39 mSv). Any two of the three groups had significant differences (all p<0.001).
Conclusion:
Prospective ECG-triggering DSCT angiography associated with a significantly lower ED than retrospective protocol, while maintaining image quality for diagnosis. Prospective ECG-triggering DSCT angiography could be used as a very important second-line diagnostic tool in infants with complex CHD.
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