title: Low-dose prospectively electrocardiogram-gated axial dual-source CT angiography in patients with pulsatile bilateral bidirectional Glenn Shunt: an alternative noninvasive method for postoperative morphological estimation.
abstract: OBJECTIVE
  To explore the clinical value of low-dose prospectively electrocardiogram-gated axial dual-source CT angiography (low-dose PGA scanning, CTA) in patients with pulsatile bilateral bidirectional Glenn shunt (bBDG) as an alternative noninvasive method for postoperative morphological estimation.
  
  
  METHODS
  Twenty patients with pulsatile bBDG (mean age 4.2±1.6 years) underwent both low-dose PGA scanning and conventional cardiac angiography (CCA) for the morphological changes. The morphological evaluation included the anatomy of superior vena cava (SVC) and pulmonary artery (PA), the anastomotic location, thrombosis, aorto-pulmonary collateral circulation, pulmonary arteriovenous malformations, etc. Objective and subjective image quality was assessed. Bland-Altman analysis and linear regression analyses were used to evaluate the correlation on measurements between CTA and CCA. Effective radiation dose of both modalities was calculated.
  
  
  RESULTS
  The CT attenuation value of bilateral SVC and PA was higher than 300 HU. The average subjective image quality score was 4.05±0.69. The morphology of bilateral SVC and PA was displayed completely and intuitively by CTA images. There were 24 SVC above PA and 15 SVC beside PA. Thrombosis was found in 1 patient. Collateral vessels were detected in 13 patients. No pulmonary arteriovenous malformation was found in our study. A strong correlation (R2>0.8, P<0.001) was observed between the measurements on CTA images and on CCA images. Bland-Altman analysis demonstrated a systematic overestimation of the measurements by CTA (the mean value of bias>0).The mean effective dose of CTA and CCA was 0.50±0.17 mSv and 4.85±1.34 mSv respectively.
  
  
  CONCLUSIONS
  CT angiography with a low-dose PGA scanning is an accurate and reliable noninvasive examination in the assessment of morphological changes in patients with pulsatile bBDG.
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Ji
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Zhaoping
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Cardiovascular Institute of Jinan Military district, Jinan, People's Republic of China.
authors.forename: Biao
authors.initials: B
authors.lastname: Si
authors.affiliation: Cardiovascular Institute of Jinan Military district, Jinan, People's Republic of China.
authors.forename: Zhiheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Duan
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Pei
authors.initials: P
authors.lastname: Nie
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Haiou
authors.initials: H
authors.lastname: Li
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Shifeng
authors.initials: S
authors.lastname: Yang
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Jiao
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, People's Republic of China.
authors.forename: Ximing
authors.initials: X
authors.lastname: Wang
mesh_terms: D000792:Angiography / Q000379:methods*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011829:Radiation Dosage; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery
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