Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT.
BACKGROUND
Precise visualization of the pulmonary vasculature is mandatory for adequate treatment of patients with pulmonary atresia and ventricular septal defect (PA-VSD). Aortopulmonary collateral arteries (APCs) can be visualized by selective injections of contrast agent in the catheterization laboratory.


OBJECTIVE
To evaluate multidetector CT (MDCT) and different image postprocessing methods for analysis of complex pulmonary blood supply in patients with PA-VSD.


METHODS
Eight patients (6 weeks to 27.8 years of age) with PA-VSD and APCs underwent MDCT and cardiac catheterization. Using multiplanar reformatting, volume rendering and semiautomatic segmentation algorithms, the aorta, pulmonary arteries and APCs were displayed. MDCT and cardiac catheterization were analyzed by two independent observers.


RESULTS
MDCT accurately imaged central pulmonary arteries (n=8), aortopulmonary shunts (n=2), right ventricular to pulmonary artery conduits (n=2) and origin, course and intrapulmonary connections of APCs (n=25), compared to X-ray angiography. A high correlation was found between the MDCT vessel diameter measurements by two independent observers (n=70, r=0.96, P<0.01) and between MDCT and angiographic vessel diameter measurements (n=68, r=0.96, P<0.01).


CONCLUSIONS
Using three-dimensional imaging software, a complex pulmonary blood supply can be non-invasively and accurately imaged with high-resolution MDCT. This technique may help to reduce the number of cardiac catheterizations or guide interventional or surgical therapy.
Department of Pediatric Cardiology, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany. gerald.greil@med.uni-tuebingen.de
Gerald F
GF
Greil
Max
M
Schoebinger
Axel
A
Kuettner
Juergen F
JF
Schaefer
Florian
F
Dammann
Claus D
CD
Claussen
Michael
M
Hofbeck
Hans-Peter
HP
Meinzer
Ludger
L
Sieverding
D000293:Adolescent; D000328:Adult; D001027:Aortography / Q000379:methods; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D003287:Contrast Media; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities / Q000000981:diagnostic imaging*; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol