Assessment of in-stent stenosis in small children with congenital heart disease using multi-detector computed tomography: a validation study.
OBJECTIVE
Our purpose was to investigate the diagnostic reliability of multi-detector computed tomography (MDCT) in assessing in-stent stenosis compared to digital angiography (DA) in small children.


BACKGROUND
Little is known about the feasibility of using MDCT to assess stents placed to treat children with congenital heart disease (CHD).


METHODS
Twenty-two children (median age [range], 2(3/4) [(1/2) to 12] years) with 42 transcatheter placed stents (median diameter: 7.2 [3.4-16.3] mm) in the pulmonary arteries (n = 36), aorta (2), PDA (1), and SVC (3) underwent both MDCT and DA due to suspected hemodynamic problems.


RESULTS
Independent "blinded" observers were able to measure stent and minimal luminal diameters in 115 out of 124 (93%) stent segments on MDCT and DA. The interobserver variability was low (mean difference: 0.5, SD 0.8 mm) with high correlation (r = 0.97; P < .0001). The percent stenosis by MDCT correlated well with DA (r = 0.89, P < .0001; mean error 2.7, SD 10.4%). For all grades of stenosis, the sensitivity and specificity for MDCT were 58% and 97%, respectively. At a threshold of approximately > or =20% stenosis sensitivity became >98%. All stent associated complications [fracture (4), vascular narrowings (11)] were diagnosed by MDCT. As the stent diameter increased, there was significantly reduced variability between MDCT and DA for in-stent stenosis (P < .0001).


CONCLUSIONS
In small children, MDCT is a feasible and promising method for assessing stent associated complications in the treatment of CHD. Cardiac surgeons and interventional cardiologists might rely on this imaging modality to plan specific interventions more precisely and to assess the results upon follow up.
Eichhorn
Joachim G
JG
Department of Radiology, Ohio State University College of Medicine, Columbus, USA. joachim_eichhorn@med.uni-heidelberg.de
Long
Frederick R
FR
Hill
Sharon L
SL
O'Donovan
Julie
J
Chisolm
Joanne L
JL
Fernandez
Soledad A
SA
Cheatham
John P
JP
D015901:Angiography, Digital Subtraction; D001027:Aortography; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012107:Research Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging