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Intravenous digital subtraction angiography (IVDSA) in children
Insights
Intravenous digital subtraction angiography (IVDSA) effectively visualizes pediatric cardiovascular structures and palliative shunts. Central venous injections yield superior image quality compared to peripheral injections for these critical assessments.
Area of Science:
- Cardiovascular Imaging
- Pediatric Radiology
- Interventional Radiology
Background:
- Intravenous digital subtraction angiography (IVDSA) is a valuable tool for evaluating complex pediatric cardiovascular conditions.
- Assessing the heart, great vessels, and palliative shunts in children requires high-quality imaging.
- Optimizing IVDSA techniques is crucial for accurate diagnosis and treatment planning in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of intravenous digital subtraction angiography (IVDSA) in visualizing the heart, great vessels, and palliative shunts in pediatric patients.
- To compare the image quality and technical success rates of peripherally versus centrally injected IVDSA procedures.
- To determine the diagnostic utility of IVDSA for specific pediatric cardiovascular lesions.
Main Methods:
- Forty-one IVDSA studies were conducted in 39 pediatric patients (aged 4 weeks to 19 years).
- Contrast agents were administered via antecubital vein cannulation (n=14) or centrally-placed catheters (n=27).
- Image quality was assessed based on technical success, motion artifacts, contrast adequacy, and extravasation.
Main Results:
- Central venous injections resulted in technically satisfactory images in 26 out of 27 procedures.
- Peripheral injections yielded unsatisfactory or limited-value studies in 4 cases due to various technical issues.
- While systemic-pulmonary shunt lesions were challenging, IVDSA provided consistently useful information for the aorta and pulmonary arteries.
Conclusions:
- Central venous access for IVDSA offers superior image quality and reliability in pediatric cardiovascular imaging.
- IVDSA is a valuable diagnostic modality for the pediatric aorta and pulmonary arteries, despite challenges with shunt visualization.
- Refined IVDSA techniques, particularly central injections, enhance diagnostic confidence in evaluating complex pediatric heart and great vessel abnormalities.
Abstract:
Forty-one intravenous digital subtraction angiographic (IVDSA) studies were performed in 39 patients aged 4 weeks to 19 years (mean: 9.4 years) in order to evaluate the heart, great vessels and palliative shunts. Contrast agents were injected via antecubital vein cannulation in 14 examinations. In the remaining 27, injections were made through centrally-placed catheters inserted via right antecubital or femoral veins. All but one of the centrally-injected procedures resulted in technically satisfactory images. Four of the peripherally-injected IVDSA studies were unsatisfactory or of limited value due to motion artefacts, insufficient contrast, equipment failure or perivenous extravasations. Systemic-pulmonary shunt lesions were difficult to image, but IVDSA of the aorta and pulmonary arteries provided consistently useful information.