Thoracic CT Angiographies in Children Using Automated Power Injection with Bolus Tracking Versus Manual Contrast...

Area of Science:

• Radiology
• Pediatric Cardiology
• Medical Imaging

Background:

• Thoracic computed tomography angiography (CTA) is crucial for diagnosing congenital heart diseases (CHDs) in children.
• Optimizing image quality while managing radiation exposure is essential in pediatric CTA.
• Contrast medium (CM) administration techniques, manual injection (MI) versus automated power injection (PI) with bolus tracking, impact image quality and radiation dose.

Purpose of the Study:

• To compare image quality and radiation exposure between manual and automated contrast medium injection for pediatric thoracic CTA in CHDs.
• To evaluate the effectiveness of automated power injectors with bolus tracking in pediatric CTA.

Main Methods:

• Retrospective analysis of 137 thoracic CTAs from 120 pediatric patients with CHDs.
• Comparison of manual injection (MI) versus power injection (PI) with bolus tracking for CM administration.
• Objective image quality assessment (attenuation, SNR, CNR) and subjective visual assessment by blinded readers.
• Calculation of effective radiation doses and assessment of injection-related complications.

Main Results:

• Automated power injection (PI) resulted in significantly higher attenuation and contrast-to-noise ratios (CNR) in cardiac structures compared to manual injection (MI).
• Visual image quality and depiction of anatomical structures were significantly better with PI than MI, rated 'good' to 'excellent' versus 'fair' to 'good'.
• Mean effective radiation dose did not significantly differ between PI and MI groups; no complications were reported for either method.

Conclusions:

• Automated contrast agent application with power injectors and bolus tracking enhances image quality in pediatric CTA for CHDs, even with low volumes/flow rates.
• This technique offers a suitable imaging solution for pediatric CHD work-up with comparable radiation doses to manual injection.
• A slight increase in radiation dose is associated with bolus tracking, but the benefits in image quality outweigh this.