Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease.
OBJECTIVE
The purpose of our study was to determine the value of three-dimensional reconstructed helical CT in the assessment of the pulmonary arteries in infants and children with complex congenital heart disease.


METHODS
Twenty patients were examined with contrast-enhanced helical CT. Three-dimensional reconstructions were performed with multiplanar reformations, maximum intensity projection, and shaded-surface display. Correlation was made with 19 echocardiograms and 14 cineangiocardiograms. All imaging studies were reviewed independently for the following parameters: the caliber of the main and branch pulmonary arteries and their confluence, the presence of stenosis, the number and caliber of aortopulmonary collaterals, and the patency of vascular shunts and conduits. Surgical confirmation, which was used as the reference standard, was available in all patients.


RESULTS
Helical CT was as accurate as angiocardiography in revealing stenotic and nonconfluent central pulmonary arteries and in revealing aortopulmonary collaterals (overall CT test parameters: sensitivity, 90%; specificity, 100%; accuracy, 93%).Three-dimensional rendition did not improve the accuracy of CT. The patency of shunts was shown equally well with CT as with angiography, but CT showed thrombosis more directly. Echocardiography was the least accurate technique in revealing pulmonary artery anatomy (accuracy, 65%), primarily because a relatively large number of studies were technically unsatisfactory to assess the study parameters.


CONCLUSIONS
Helical CT angiocardiography with three-dimensional reconstruction is superior to echocardiography for the noninvasive assessment of pulmonary artery anatomy in patients with complex congenital heart disease. Helical CT may be used as a complementary technique and occasionally as a substitute for the diagnostic imaging portion of cardiac catheterization with cineangiocardiography.
Department of Radiological Sciences, Center for the Health Sciences, UCLA Medical Center, Los Angeles, CA 90095-1721, USA.
S J
SJ
Westra
J A
JA
Hill
J C
JC
Alejos
A
A
Galindo
M I
MI
Boechat
H
H
Laks
D000790:Angiocardiography; D002648:Child; D002675:Child, Preschool; D002932:Cineangiography; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D003287:Contrast Media