NON-ECG-GATED CARDIAC CT IN CHILDREN WITH CONGENITAL HEART DISEASE
Khasanova K.A.1,2, Ternovoy S.K.2,3
1 - Morozov Children's City Clinical Hospital.
2 - Sechenov University.
3 - A.L. Myasnikova National Medical Research Center of Cardiology. Moscow, Russia.
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here are different strategies for reducing the effective dose when performing cardiac CT in children, most of them are aimed for changing the technical parameters of the CT protocol and depend on the specification of the CT scanner. An alternative and affordable option for reducing the dose during cardiac CT in children is non-ECG-gated cardiac CT scanning. There are still a small number of publications on the possibilities and limitations of non-ECG-gated cardiac CT in children with congenital heart defects (CHD).
Purpose. To evaluate the possibilities of non-ECG-gated cardiac CT in the diagnosis and preoperative planning of CHD in children.
Materials and methods. The study included 338 children with an incoming clinical diagnosis of congenital heart disease. The group of patients who underwent non-ECG-gated cardiac CT included 201 children (59.6%), 137 children underwent CT with retrospective ECG synchronization (41%). For all studies, effective doses were calculated, as well as a comparison of the capabilities of CT protocols (with and without ECG synchronization) in the diagnosis of CHD and the identification of concomitant anomalies that play an important role in planning patient management tactics. All the CT data obtained were compared with the results of direct angiography and intraoperative data.
Results. In the diagnosis of all groups of CHD and most clinically significant concomitant intra- and extracardiac abnormalities, the non-ECG-gated cardiac CT proved to be a highly accurate tool without a statistically significant difference in effectiveness compared with the synchronized CT protocol (p>0.05). A significant (p<0.05) decrease in the capabilities of the unsynchronized protocol in comparison with CT with retrospective ECG synchronization in our study was the determination of concomitant anomalies of the coronary arteries (CA) (sensitivity 33.3%, specificity 97.12%, accuracy 93.2%) and the assessment of the functional state of the large aortopulmonary collateral arteries (accuracy 73.6%). The CT protocol with retrospective ECG synchronization in determining stenoses of the large aortopulmonary collateral arteries and anomalies of the coronary bed was more accurate than non-ECG-gated cardiac CT (p<0.05), accuracy 93.2% and 98.1%, respectively. Effective dose in group of patients who underwent non-ECG-gated cardiac CT was significally lower than in the group with a synchronized protocol and amounted to 2.17 ± 0.687, with retrospective ECG synchronization - 4.1 ±1.24 mSv (p<0.01).
Discussion. Our results demonstrate the high efficiency of non-ECG-gated cardiac CT in determining the type of CHD, however, the method has limited diagnostic capabilities in assessing surgical risks associated with CA abnormalities and the presence of stenoses of alternative sources of pulmonary blood supply.
Conclusion. In patients with pathology of the aortic arch, common arterial trunk, anomalies
of systemic and pulmonary venous return, when planning surgical or endovascular correction, the use of a non-ECG-gated cardiac CT when planning surgical or endovascular correction of CHD is an acceptable tool to reduce the dose burden on a child. In all other cases: before performing a coronary artery reimplantation or infundibulotomy of the excretory part of the right ventricle (conotruncus anomalies), as well as for patients with cardiac abnormalities associated with hypoplasia of the pulmonary artery system and the potential presence of aortopulmonary collaterals, a CT scan of the heart should be performed using ECG synchronization.
Keywords: CHD, CT, non-ECG-gated cardiac CT, congenital heart defects, coronary arteries, CA.
Corresponding author: Khasanova K.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Khasanova K.A., Ternovoy S.K. Non-ECG-gated cardiac CT in children with congenital heart disease. REJR 2024; 14(3):45-57. DOI: 10.21569/2222-7415-2024-14-3-45-57.
Received: 01.05.24 Accepted: 11.09.24