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Cardiac Electron-Beam CT in Children Undergoing Surgical Repair for Pulmonary Atresia¹

¹ From the Department of Radiological Sciences (S.J.W., J.H., M.F.M.G., M.I.B.) and the Divisions of Pediatric Cardiology (A.G.) and Cardiothoracic Surgery (H.L.), UCLA School of Medicine, Los Angeles, Calif. From the 1997 RSNA scientific assembly. Received October 29, 1998; revision requested December 28; revision received February 2, 1999; accepted April 30. Address reprint requests to S.J.W., Department of Radiology, Children's Memorial Hospital, 2300 Children's Plaza #9, Chicago, IL 60614-3394 (e-mail: SWestra@childrensmemorial.org).

PURPOSE: To study whether electron-beam computed tomography (CT) is as accurate as conventional angiocardiography for the characterization of the true pulmonary arteries and the aortopulmonary collateral vessels in children undergoing surgical correction for pulmonary atresia.

MATERIALS AND METHODS: Twenty-three children with pulmonary atresia underwent 48 cardiac-triggered dynamic contrast material–enhanced electron-beam CT studies. Correlation was made with surgical findings in all patients and with 34 cineangiocardiograms. Data from reconstructed electron-beam CT images and cineangiocardiograms were reviewed for the presence, caliber, and origin of true pulmonary arteries and aortopulmonary collateral vessels; for stenosis; for thrombosis; and for the patency of vascular conduits and shunts.

RESULTS: Electron-beam CT was more sensitive than angiography in the identification of hypoplastic and/or nonconfluent branch pulmonary arteries, coronary anomalies, conduit and shunt thrombosis, and other postoperative complications, but it was less sensitive in the demonstration of stenoses at collateral vascular origins and anastomoses. Overall test parameters for electron-beam CT and angiography to characterize pulmonary vascularity were similar (sensitivity, 0.94 vs 0.90; specificity, 0.99 for both; accuracy, 0.97 vs 0.95). Three-dimensional reconstructions, although they were helpful in conveying electron-beam CT findings to referring cardiologists and surgeons, did not add diagnostic information to that displayed on images of the transverse sections.

CONCLUSION: Electron-beam CT complements conventional diagnostic angiocardiography in preoperative evaluation, especially in the detection of hypoplastic pulmonary arteries. It is well suited for postoperative shunt surveillance.

Index terms: Angiocardiography, 51.1242, 56.1242 • Computed tomography (CT), electron beam, 51.12113, 56.12113 • Computed tomography, in infants and children • Computed tomography, three-dimensional, 51.12117, 56.12117 • Heart, abnormalities, 515.142, 533.171 • Heart, CT, 51.12113, 51.12117, 56.12113, 56.12117 • Pulmonary arteries, abnormalities, 564.155

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