title: Using multidetector-row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility.
abstract: BACKGROUND
  Echocardiography is the first-line modality for the investigation of neonatal congenital heart disease. Diagnostic cardiac catheterization, which has a small but recognized risk, is usually performed if echocardiography fails to provide a confident evaluation of the lesions.
  
  
  OBJECTIVE
  To verify the technical and clinical feasibilities of replacing diagnostic cardiac catheterization with multidetector-row CT (MDCT) in neonatal complex congenital heart disease.
  
  
  METHODS
  Over a 1-year period we prospectively enrolled all neonates with complex congenital heart disease referred for diagnostic cardiac catheterization after initial assessment by echocardiography. MDCT was performed using a 40-detector-row CT scanner with dual syringe injection. A multidisciplinary congenital heart disease team evaluated the MDCT images and decided if further diagnostic cardiac catheterization was necessary. The accuracy of MDCT in detecting separate cardiovascular anomalies and bolus geometry of contrast enhancement were calculated.
  
  
  RESULTS
  A total of 14 neonates were included in the study. No further diagnostic cardiac catheterization was needed in any neonate. The accuracy of MDCT in diagnosing separate cardiovascular anomalies was 98% (53/54) with only one atrial septal defect missed in a patient with coarctation syndrome. The average cardiovascular enhancement in evaluated chambers was 471 HU. No obvious beam-hardening artefact was observed.
  
  
  CONCLUSIONS
  The technical and clinical feasibility of MDCT in complex congenital heart disease in neonates is confirmed. After initial assessment with echocardiography, MDCT could probably replace diagnostic cardiac catheterization for further anatomical clarification in neonates.
authors.affiliation: 407 Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Tain
authors.initials: T
authors.lastname: Lee
authors.forename: I-Chen
authors.initials: IC
authors.lastname: Tsai
authors.forename: Yun-Ching
authors.initials: YC
authors.lastname: Fu
authors.forename: Sheng-Lin
authors.initials: SL
authors.lastname: Jan
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Yen
authors.initials: Y
authors.lastname: Chang
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chen
mesh_terms: D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007472:Iohexol; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D015588:Observer Variation; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012965:Sodium Chloride / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; D012965:Sodium Chloride