Safety and accuracy of dual-source coronary computed tomography angiography in the pediatric population.
BACKGROUND
High heart rates and radiation sensitivity have limited the use of coronary computed tomography angiography (CTA) in pediatric patients.


OBJECTIVE
A contemporary evaluation of image quality and reduction in radiation exposure with dual-source CT technology has not been reported in a large cohort of pediatric patients undergoing coronary angiography.


METHODS
Consecutive coronary CTA scans (n = 71) in 70 pediatric patients were retrospectively reviewed. Metoprolol was administered for heart rate control. Scans were divided by acquisition mode into 3 groups: retrospective electrocardiogram (ECG)-triggered spiral, prospective ECG-triggered, and prospective ECG-triggered high-pitch spiral scans. Heart rate, radiation dose, image quality, and diagnostic confidence were compared between groups.


RESULTS
Median decrease in heart rate with metoprolol was 24% ± 14%. Median effective age-adjusted radiation dose for the entire group was 0.97 ± 1.20 mSv. Retrospective ECG-triggered scans had a median dose of 1.71 ± 1.4 mSv, prospectively ECG-triggered scans had a median dose of 0.9 ± 1.1 mSv, and prospectively ECG-triggered high-pitch spiral scans had a median effective dose of 0.27 ± 0.4 mSv. The difference between groups was statistically significant (P < 0.05). The contrast-to-noise ratio and the image quality score were similar between groups.


CONCLUSIONS
Dual-source coronary CTA with a β-blocker protocol uniformly achieves diagnostic coronary scans at a low radiation dose in pediatric patients. Image quality and diagnostic confidence are excellent for all scan modes in a wide spectrum of patients.
Children's Heart Clinic Minneapolis, MN, USA.
B Kelly
BK
Han
Jana
J
Lindberg
David
D
Overman
Robert S
RS
Schwartz
Katharine
K
Grant
John R
JR
Lesser
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000367:Age Factors; D055424:Cardiac-Gated Imaging Techniques / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004562:Electrocardiography; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008790:Metoprolol / Q000008:administration & dosage; D008910:Minnesota; D061214:Patient Safety; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D036542:Tomography, Spiral Computed
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol