Cardiac computed tomography compared to transthoracic echocardiography in the management of congenital heart disease.
OBJECTIVE
To compare cardiac CT and transthoracic echocardiography (TTE) as diagnostic utilities in congenital heart disease (CHD) and to determine their advantages and limitations.


BACKGROUND
TTE is widely used in the evaluation of CHD. Recent reports suggested an increasing role of CT. However, there are few quantitative data on its diagnostic accuracy.


METHODS
We investigated a total of 162 patients (51.24% male; mean age: 16.06 +/-+/- 17.92) with congenital heart defects, who underwent electron beam CT (EBCT) and TTE between March 2002 and June 2005. We retrospectively analyzed a total of 667 findings, stratified for age and anatomic categories.


RESULTS
EBCT and TTE findings are concordant in patients below 1 year of age (85.43% agreement). EBCT had poor sensitivity and specificity in detecting anomalies of cardiac chambers (0.68, 0.58), but was useful for great arteries (0.91, 0.85). Furthermore, sensitivity and specificity were remarkably different in systemic venous return (0.93, 0.3) and coronary vessels (0.8, 0.33) because of "false positive" findings, which were later found to be most likely real findings not detectable by reference standard. The opposite was true for cardiac valves (0.66, 0.89) and septa (0.76, 0.91).


CONCLUSIONS
EBCT delineates findings related to systemic venous return and coronary vessels well due to simultaneous visualization of complex anatomy. This advantage does not seem to apply in patients below 1 year of age with better acoustic windows. TTE was found more suitable for cardiac valves and septal defects because of the availability of flow imaging.
Beier
Ulf H
UH
Department of Pediatrics, Division of Pediatric Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA.
Jelnin
Vladimir
V
Jain
Supriya
S
Ruiz
Carlos E
CE
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed