Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants

Abstract

Purpose To evaluate the sensitivity, specificity, and interobserver reliability of high-pitch dual-source computed tomography angiography (CTA) in the detection of anomalous pulmonary venous connection (APVC) in infants with congenital heart defects and to assess the associated radiation exposure.

Materials and Methods 78 pulmonary veins in 17 consecutively enrolled patients with congenital heart defects (6 females; 11 males; median age: 6 days; range: 1–299 days) were retrospectively included in this study. All patients underwent high-pitch dual-source CTA of the chest at low tube voltages (70 kV). APVC was evaluated independently by two radiologists. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interobserver agreement were determined. For standard of reference, one additional observer reviewed CT scans, echocardiography reports, clinical reports as well as surgical reports. In cases of disagreement the additional observer made the final decision based on all available information.

Results Detection of APVC with high-pitch dual-source CTA revealed a good sensitivity (91 %) and specificity (99 %), with PPV and NPV of 98 % and 97 %. Interobserver agreement was almost perfect (Kappa = 0.84). The median DLP was 3.8 mGy*cm (IQR 3.3–4.7 mGy*cm) and the median radiation dose was 0.33 mSv (IQR 0.26–0.39 mSv).

Conclusion High-pitch dual-source CTA in infants with congenital heart defects allows for accurate and reliable assessment of APVC at a low radiation dose.

Key Points: 

• High-pitch dual-source CTA enables detection of anomalous pulmonary vein connection with high sensitivity in infants.

• Interrater reliability in the detection of anomalous pulmonary vein connection with high-pitch dual-source CTA is almost perfect.

• Radiation dose of high-pitch dual-source CTA in the cardiac examination of infants is low.

Citation Format

• Well L, Weinrich JM, Meyer M et al. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. Fortschr Röntgenstr 2021; 193: 551 – 558

Zusammenfassung

Ziel Bewertung der Sensitivität, Spezifität und Interrater-Reliabilität der High-Pitch-Dual-Source-Computertomografie-Angiografie (CTA) in der Detektion von Pulmonalvenenfehlmündungen bei Säuglingen mit angeborenen Herzfehlern und Bewertung der damit verbundenen Strahlenbelastung.

Material und Methoden In diese retrospektive Studie wurden 78 Lungenvenen aus 17 konsekutiv untersuchten Säuglingen mit angeborenen Herzfehlern eingeschlossen (6 Mädchen, 11 Jungen; Medianalter 6 Tage, Range 1–299 Tage). Bei allen Patienten wurde eine High-Pitch-Dual-Source-CTA des Thorax bei niedriger Röhrenspannung (70 kV) durchgeführt. Das Vorliegen von Pulmonalvenenfehlmündungen wurde von 2 Radiologen unabhängig voneinander bewertet. Sensitivität, Spezifität, positive (PPV) und negative prädiktive Vorhersagewerte (NPV) sowie die Interrater-Reliabilität wurden bestimmt. Als Referenzstandard diente die Kombination aus CT-Scans, Befunden der Echokardiografie, klinischen Berichten sowie Operationsberichten, die von einem erfahrenen Kinderradiologen in Zusammenschau ausgewertet wurden. Dieser entschied im Fall inkongruenter Befunde über die korrekte Interpretation.

Ergebnisse Die Detektion von Pulmonalvenenfehlmündungen mit der High-Pitch-Dual-Source-CTA gelang mit guter Sensitivität (91 %) und Spezifität (99 %), bei PPV und NPV von 98 % und 97 %. Die Interrater-Reliabilität war nahezu perfekt (Kappa = 0,84). Der Median des DLP betrug 3,8 mGy*cm (IQR 3,3–4,7 mGy*cm), die effektive Dosis betrug im Median 0,33 mSv (IQR 0,26–0,39 mSv).

Schlussfolgerung Die High-Pitch-Dual-Source-CTA bei Säuglingen mit angeborenen Herzfehlern ermöglicht eine genaue und zuverlässige Detektion von Lungenvenenfehlmündungen bei niedriger Strahlendosis.

Kernaussagen: 

• Die High-Pitch-Dual-Source-CTA ermöglicht die Detektion von Pulmonalvenenfehlmündungen bei Säuglingen mit hoher Sensitivität.

• Die Interrater-Reliabilität bei der Erkennung von Pulmonalvenenfehlmündungen mit High-Pitch-Dual-Source-CTA ist hoch.

• Die Strahlendosis der High-Pitch-Dual-Source-CTA bei der kardialen Untersuchung von Säuglingen ist gering.

Key words

cardiac - CT-angiography - pediatric - pulmonary veins - radiation dose

• References

• 1 Anderson R, Macartney F. Pulmonary venous abnormalities. In: Paediatr Cardiol 2nd Editio. London: Churchill, Livingstone; 2002: 867-899
• 2 Hughes C, Rumore P. Anomalous pulmonary veins. Arch Pathol 1944; 37: 364-366
• 3 Schultz AH, Localio AR, Clark BJ. et al. Epidemiologic features of the presentation of critical congenital heart disease: Implications for screening. Pediatrics 2008; 121: 751-757
• 4 Tumanyan MR, Filaretova OV, Chechneva VV. et al. Repair of complete atrioventricular septal defect in infants with down syndrome: Outcomes and long-term results. Pediatr Cardiol 2015; 36: 71-75
• 5 Glöckler M, Halbfaß J, Koch A. et al. Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases. Eur J Cardiothorac Surg 2014; 45: 1060-1065
• 6 Padalino MA, Cavalli G, De Franceschi M. et al. Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair: A 22-Year Experience. J Card Surg 2014; 29: 678-685
• 7 Jiang L, Xie LJ, Yang ZG. et al. Preoperative evaluation of anomalous pulmonary venous connection using dual-source computed tomography: Comparison with echocardiography. Eur J Radiol 2017; 94: 107-114
• 8 Slovis TL. Sedation and anesthesia issues in pediatric imaging. Pediatr Radiol 2011; 41 (Suppl. 02) 514-516
• 9 Rompel O, Glöckler M, Janka R. et al. Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction. Pediatr Radiol 2016; 46: 462-472
• 10 Watson TG, Mah E, Joseph Schoepf U. et al. Effective radiation dose in computed tomographic angiography of the chest and diagnostic cardiac catheterization in pediatric patients. Pediatr Cardiol 2013; 34: 518-524
• 11 Türkvatan A, Tola HT, Kutlutürk N. et al. Low-Dose Computed Tomographic Imaging of Partial Anomalous Pulmonary Venous Connection in Children. World J Pediatr Congenit Heart Surg 2017; 8: 590-596
• 12 Achenbach S, Barkhausen J, Beer M. et al. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomografie und Magnetresonanztomografie. RoFo Fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgeb. Verfahren 2012; 184: 345-368
• 13 Deak PD, Smal Y, Kalender WA. Multisection CT protocols: Sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 2010; 257: 158-166
• 14 Nau D, Wuest W, Rompel O. et al. Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age. J Cardiovasc Comput Tomogr 2019; 13: 226-233
• 15 Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977; 33: 159
• 16 Lotz J, Beerbaum P, Steinmetz M. Partial Pulmonary Venous Anomalies. In: Gutberlet M. (ed.) Diagnostic Imaging Congenit. Hear. Defects Diagnosis Image-Guided Treatmen. 1st Editio. Georg Thieme Verlag; 2020: 235-247
• 17 Lee HJ, Kim YJ, Hur J. et al. Low-dose electrocardiography synchronized nonenhanced computed tomography for assessing left atrium and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol 2011; 108: 536-540
• 18 Kim TH, Kim YM, Suh CH. et al. Helical CT Angiography and Three-Dimensional Reconstruction of Total Anomalous Pulmonary Venous Connections in Neonates and Infants. Am J Roentgenol 2000; 175: 1381-1386
• 19 Hammon M, Rompel O, Seuss H. et al. Accuracy and Specific Value of Cardiovascular 3D-Models in Pediatric CT-Angiography. Pediatr Cardiol 2017; 38: 1540-1547
• 20 Zhang Z, Zhang L, Xie F. et al. Echocardiographic diagnosis of anomalous pulmonary venous connections: Experience of 84 cases from 1 medical center. Medicine (Baltimore) 2016; 95: e5389
• 21 Gutberlet M, Abdul-Khaliq H, Grothoff M. et al. Vergleich der transthorakalen 3D-echokardiographie mit der MRT zur bestimmung linksventrikulärer volumina bei patienten mit pathologischer ventrikelgeometrie aufgrund angeborener herzfehler. RoFo Fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgeb Verfahren 2003; 175: 942-951
• 22 Abdul-Khaliq H, Gutberlet M. Technical Basics of Diagnostic and Interventional Imaging – Echocardiography. In: Gutberlet M. (ed.) Diagnostic Imaging Congenit. Hear. Defects Diagnosis Image-Guided Treatmen. 1st Edition. Georg Thieme Verlag; 2020: 43-52
• 23 Brown VE, De Lange M, Dyar DA. et al. Echocardiographic spectrum of supracardiac total anomalous pulmonary venous connection. J Am Soc Echocardiogr 1998; 11: 289-293
• 24 Valsangiacomo ER, Levasseur S, McCrindle BW. et al. Contrast-enhanced MR angiography of pulmonary venous abnormalities in children. Pediatr Radiol 2003; 33: 92-98
• 25 Sørensen TS, Körperich H, Greil GF. et al. Operator-independent isotropic three-dimensional magnetic resonance imaging for morphology in congenital heart disease: A validation study. Circulation 2004; 110: 163-169
• 26 Fenchel M, Greil GF, Martirosian P. et al. Three-dimensional morphological magnetic resonance imaging in infants and children with congenital heart disease. Pediatr Radiol 2006; 36: 1265-1272
• 27 Fratz S, Chung T, Greil GF. et al. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15: 1-26