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Induced apnea enhances image quality and visualization of cardiopulmonary anatomic during contrastenhanced cardiac
Murali Chakravarthy1, Gubbihalli Sunilkumar, Sumant Pargaonkar
1Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India.
Insights
Induced apnea significantly improves cardiac CT angiography image quality in pediatric patients with congenital heart disease. This technique reduces motion artifacts, enhancing visualization of critical cardiopulmonary structures without significant added risk.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Anesthesiology
Background:
- Congenital heart diseases require detailed imaging for diagnosis and management.
- Computed tomographic (CT) angiography is crucial for visualizing complex cardiac and pulmonary structures.
- Motion artifacts can degrade image quality in pediatric CT angiography.
Purpose of the Study:
- To evaluate the impact of induced apnea on the quality of cardiopulmonary structures in CT angiography images.
- To assess the reduction of motion artifacts during pediatric cardiac CT angiography with induced apnea.
Main Methods:
- Retrospective analysis of 46 pediatric patients undergoing cardiac CT angiography.
- Comparison between a group with induced apnea and a group without induced apnea.
- Induced apnea was achieved using suxamethonium under general anesthesia, followed by contrast-enhanced CT angiography.
Main Results:
- Excellent image quality was achieved in 89% of studies with induced apnea versus 30% without.
- Induced apnea resulted in absent or minimal motion artifacts in 94% of cases.
- Significant improvement in image quality and reduction of motion artifacts were observed in the apnea group (P < 0.000).
Conclusions:
- Induced apnea is an effective technique to enhance cardiac CT angiography image quality in pediatric patients with congenital heart disease.
- The method significantly reduces motion artifacts, improving visualization of key structures.
- This technique does not appear to introduce significant additional morbidity.
Objective:
The purpose of our study was to determine the effect of induced apnea on quality of cardiopulmonary structures during computerized tomographic (CT) angiography images in children with congenital heart diseases.
Methods:
Pediatric patients with congenital heart defects undergoing cardiac CT angiography at our facility in the past 3 years participated in this study. The earlier patients underwent cardiac CT angiography without induced apnea and while, later, apnea was induced in patients, which was followed by electrocardiogram gated cardiac CT angiography. General anesthesia was induced using sleep dose of intravenous propofol. After the initial check CT, on request by the radiologist, apnea was induced by the anesthesiologist by administering 1 mg/kg of intravenous suxamethonium. Soon after apnea ensued, the contrast was injected, and CT angiogram carried out. CT images in the "apnea group" were compared with those in "nonapnea group." After the completion of the procedure, the patients were mask ventilated with 100% oxygen till the spontaneous ventilation was restored.
Results:
We studied 46 patients, of whom 36 with apnea and yet another 10 without. The quality of the image, visualization of structures such as cardiac wall, outflow tracts, lung field, aortopulmonary shunts, and coronary arteries were analyzed and subjected to statistical analysis (Mann-Whitney U, Fischer's exact test and Pearson's Chi-square test). In the induced apnea group, overall image quality was considered excellent in 89% (n = 33) of the studies, while in the "no apnea group," only 30% of studies were excellent. Absent or minimal motion artifacts were seen in a majority of the studies in apnea group (94%). In the nonapnea group, the respiratory and body motion artifacts were severe in 50%, moderate in 30%, and minimal in 20%, but they were significantly lesser in the apnea group. All the studied parameters were statistically significant in the apnea group in contrast to nonapnea group (P < 0.000).
Conclusion:
The image quality of cardiac CT angiography greatly improves, and motion artifact significantly decreases with the use of induced apnea in pediatrics patients being evaluated for congenital heart disease. This technique poses no additional morbidity of significance.
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