Non-invasive assessment of congenital pulmonary vein stenosis in children using cardiac-non-gated CT with 64-slice technology.
BACKGROUND
Management of congenital pulmonary vein stenosis is a diagnostic challenge. Echocardiography may be insufficient and thus cardiac catheterization remains the reference standard in this setting. The aim of the study was to investigate the accuracy of cardiac-non-gated CT using 64-slice technology in detecting congenital pulmonary vein stenosis in children.


METHODS
CT examinations were consecutively performed from May 2005 to December 2006 in 13 children aged 1.5-12 months (median 5 months) for suspected congenital pulmonary vein stenosis. Cardiac-non-gated CT acquisitions were performed after the peripheral injection of contrast agent. Pulmonary veins were evaluated for their pattern of connectivity from the lung to the left atrium and for the presence of stenosis. CT findings of pulmonary vein stenosis were compared with combined findings available from echocardiography, catheterization and surgery.


RESULTS
Pulmonary veins from the right lung (n=29) and left lung (n=26) were evaluated as separate structures (N=55). Of the 55 structures, 32 had surgical and/or catheterization data and 45 had echocardiography for comparison. CT visualized 100% (55/55) of the investigated structures, while echocardiography visualized 82% (45/55). In the 13 subjects CT identified 10 stenotic pulmonary veins. CT confirmed the echocardiography suspicion of pulmonary vein stenosis in 100% (7/7) and established a new diagnosis in 3 other patients. CT agreed with surgery/catheterization in 100% (10/10) of the available comparisons.


CONCLUSIONS
Cardiac-non-gated CT assessed the pulmonary veins more completely than echocardiography and should be considered as a viable alternative for invasive pulmonary venography for detecting pulmonary vein stenosis in children.
Ou
Phalla
P
Université Paris Descartes, Faculté de Médecine Necker-Enfants Malades, Department of Pediatric Radiology, Paris, France. phalla.ou@nck.aphp.fr
Marini
Davide
D
Celermajer
David S
DS
Agnoletti
Gabriella
G
Vouhé
Pascal
P
Sidi
Daniel
D
Bonnet
Damien
D
Brunelle
Francis
F
D000792:Angiography / Q000379:methods*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D011668:Pulmonary Veno-Occlusive Disease / Q000151:congenital* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*