Three-dimensional computed tomography in children with compression of the central airways complicating congenital heart disease.
OBJECTIVE
We investigated the quality and usefulness of spiral computed tomography and three-dimensional reconstruction in children with obstruction of the central airways as a complication of congenital heart disease.


METHODS
Spiral computed tomography with three-dimensional reconstruction was performed in 49 children with obstruction of the central airways seen as a complication of congenital heart disease. Spiral scanning was performed during breathing in 40, and after sedation with chloral hydrate in 38. Contrast medium was administered through a pedal venous route in 42. We analyzed the motion artifact, additional information provided by, and clinical usefulness, of the three-dimensional images. We also investigated the factors influencing the quality of the images.


RESULTS
Stenoses were seen in the trachea in 21 patients, and in bronchuses in 28. Their causes were an anomaly of the aortic arch in 6, posterior displacement of the aortic arch in 7, posterior displacement of the ascending aorta in 5, compression of the brachiocephalic artery in 5, absent pulmonary valve syndrome in 6, displaced or dilated cardiovascular structure in 17, and pulmonary arterial sling in 2. Motion artifact caused mild or negligible degradation of images in all patients except 6. Breath-holding in non-sedated children produced more severe motion artifact than did cardiovascular pulsation. Three-dimensional images provided additional information over two-dimensional images in 11, and provided clinically useful information in 10. Contrast injection via the pedal route was better for the quality of three-dimensional images than brachiocephalic injection (p = 0.013).


CONCLUSIONS
Three-dimensional computed tomography is useful in evaluation of obstruction of the central airways in children with congenital heart disease. Despite the fact that motion artifact is unavoidable, the quality of three-dimensional images is acceptable for making a proper and accurate diagnosis. A pedal route is recommended for injection of contrast medium.
Kim
Yang Min
YM
Department of Radiology, Sejong General Hospital & Sejong Heart Institute, Pucheon, Kyunggi-do, South Korea. ymkim11@be.md
Yoo
Shi-Joon
SJ
Kim
Tae Hoon
TH
Park
In Seung
IS
Kim
Woong Han
WH
Lee
Jae Young
JY
Han
Mi Young
MY
D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery; D016477:Artifacts; D001980:Bronchi / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D013504:Cardiovascular Surgical Procedures; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods; D014132:Trachea / Q000098:blood supply / Q000473:pathology / Q000601:surgery