title: Contrast medium application in pediatric high-pitch cardiovascular CT angiography: manual or power injection?
abstract: BACKGROUND
  Dual-source CT offers accurate depiction of cardiac structures in children with congenital heart disease. For cardiac CT, optimal enhancement of the cardiovascular structures is essential. There is considerable controversy about the administration of contrast medium (CM) in infants and small children, with either a power injector or a manual (hand) injection.
  
  
  OBJECTIVE
  The aim of this study was to compare image quality with power injection of CM (study group) and manual injection (control group).
  
  
  METHODS
  Thirty-four patients (study group, 6.8 ± 9.6 months and control group, 4.6 ± 8.9 months, nonrandomized) underwent dual-source CT angiography of the chest using a prospective electrocardiography-triggered high-pitch spiral mode (pitch, 3.4; 80 kV). In the study group (17 patients), a power injector was used, and in the control group (17 patients, historical group), manual CM injection had been performed. To assess image quality, both subjective and objective parameters were evaluated independently by 2 experienced radiologists.
  
  
  RESULTS
  Subjective overall image quality, signal-to-noise ratio, and contrast-to-noise ratio were significantly higher using power injection compared with manual injection (P < .05). However, depiction of cardiovascular structures did not differ significantly between both groups in all evaluated regions except the superior vena cava and the coronary arteries.
  
  
  CONCLUSIONS
  In infants and small children with congenital heart disease, both manual and power injector protocols allowed for diagnostic imaging of cardiac and extracardiac structures. However, image quality and vascular attenuation were superior using a power injector.
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany. Electronic address: marc.saake@uk-erlangen.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Saake
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lell
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Rompel
authors.affiliation: Department of Pediatric Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Gloeckler
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Eller
authors.affiliation: Department of Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, Erlangen 91054, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wuest
mesh_terms: D000367:Age Factors; D055424:Cardiac-Gated Imaging Techniques; D016022:Case-Control Studies; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007267:Injections; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide
keywords: CT; Cardiac; Contrast medium; Infant; Injection; Pediatric