title: Prospective ECG-triggering cardiac CT for infants with complex congenital heart disease using low-dose contrast medium, low tube voltage, and adaptive statistical iterative reconstruction.
abstract: OBJECTIVE
  To demonstrate the clinical value of prospective electrocardiography (ECG)-triggered cardiac computed tomography (CT) with low concentration contrast medium, low tube voltage, and adaptive statistic iterative reconstruction (ASIR) to reduce both radiation and contrast dose in examining infants with complex congenital heart disease (CHD).
  
  
  METHODS
  Forty-four consecutive infants (19 male, 25 female, age: 8.06±4.33 months, weight: 7.31±1.36 kg) with complex CHD underwent prospective ECG-triggered low-dose cardiac CT using 80 kVp and 120 mA. The contrast agent was iodixanol (270 mg iodine/ml, Visipaque, GE Healthcare, Co. Cork, Ireland). Cardiac CT images were reconstructed with 70% ASIR. The quantitative CT image quality was assessed by image noise in adipose tissue and contrast-to-noise ratio (CNR) in the aorta. The qualitative image analysis was performed on a five-point grading scale by two independent reviewers and interobserver variability was calculated. The results of 32 CT examinations were also compared with the available surgical results for diagnostic accuracy evaluation.
  
  
  RESULTS
  The effective dose was 0.55±0.10 mSv for the patient population. The iodine load was 3.95±0.73 g iodine. Image noise in adipose tissue was 16.24±1.42 HU and CNR in aorta was 21.90±7.10. All images were acceptable for diagnosis with an average score of 4.52±0.38 and good agreement between reviewers (kappa=0.75). Compared to the surgery results in 32 cases, CT was 97% and 88% accurate diagnosing extracardiac and intracardiac defects, respectively.
  
  
  CONCLUSIONS
  Prospective ECG-triggered cardiac CT using 80 kVp, low-concentration iodinated contrast agent (270 mg iodine/ml) and 70% ASIR reconstruction provides excellent image quality and accurate diagnosis for complex congenital heart disease in infants with reduced contrast medium dose and low radiation dose.
authors.affiliation: Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China.
authors.forename: W
authors.initials: W
authors.lastname: Gao
authors.affiliation: Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China. Electronic address: zyumin2002@gmail.com.
authors.forename: Y-M
authors.initials: YM
authors.lastname: Zhong
authors.affiliation: Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China.
authors.forename: A-M
authors.initials: AM
authors.lastname: Sun
authors.affiliation: Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China.
authors.forename: L-W
authors.initials: LW
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University Medical School, No. 1678 Dong Fang Road, Shanghai 200127, PR China.
authors.forename: H-S
authors.initials: HS
authors.lastname: Qiu
authors.affiliation: CT Research Center, GE Healthcare China, Bejing, PR China.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Li
mesh_terms: D057791:Cardiac Imaging Techniques; D003287:Contrast Media / Q000008:administration & dosage*; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014283:Triiodobenzoic Acids / Q000008:administration & dosage*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol