Skip to main content

Advertisement

SpringerLink
Log in

Feasibility and utility of dual-energy chest CTA for preoperative planning in pediatric pulmonary artery reconstruction

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The purpose of this study was to assess in pediatric pulmonary artery (PA) reconstruction candidates the feasibility and added utility of preoperative chest computed tomography angiography (CTA) using dual-energy technique, from which perfused blood volume (PBV)/iodine maps can be generated as a surrogate of pulmonary perfusion. Pediatric PA reconstruction patients were prospectively recruited for a new dose-neutral dual-energy CTA protocol. For each case, the severity of anatomic PA obstruction was graded by two pediatric cardiovascular radiologists in consensus using a modified Qanadli index. PBV maps were qualitatively reviewed and auto-segmented using Siemens syngo.via software. Associations between Qanadli scores and PBV were assessed with Spearman correlation (r) and ROC analysis. Effective radiation doses were estimated from dose-length product and ICRP 103 k-factors, using cubic Hermite spline interpolation. 19 patients were recruited with mean (SD) age of 6.0 (5.1), 11 (57.9%) female, 11 (73.7%) anesthetized. Higher QS correlated with lower PBV, both on a whole lung (r =  − 0.54, p < 0.001) and lobar (r =  − 0.50, p < 0.001) basis. The lung with lowest absolute PBV was predictive of the lung with highest Qanadli score, with AUC of 0.70 (95% CI 0.47–0.93). Qualitatively, PBV maps were heterogeneous, corresponding to multifocal PA stenoses, with decreased iodine content in areas of most severe obstruction. In conclusion, dual-energy chest CTA is feasible for pediatric PA reconstruction candidates. PBV maps show deficits in regions of more severe anatomic obstruction and may serve as a novel biomarker in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mainwaring RD, Ibrahimiye AN, Hanley FL (2016) Surgical technique for repair of peripheral pulmonary artery stenosis and other complex peripheral reconstructions. Ann Thorac Surg 102(2):e181–e183

    Article  PubMed  Google Scholar 

  2. Carrillo SA, Mainwaring RD, Patrick WL et al (2015) Surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals with absent intrapericardial pulmonary arteries. Ann Thorac Surg 100(2):606–614

    Article  PubMed  Google Scholar 

  3. McElhinney DB, Reddy VM, Hanley FL (1998) Tetralogy of Fallot with major aortopulmonary collaterals: early total repair. Pediatr Cardiol 19(4):289–296

    Article  CAS  PubMed  Google Scholar 

  4. Ikai A (2018) Surgical strategies for pulmonary atresia with ventricular septal defect associated with major aortopulmonary collateral arteries. Gen Thorac Cardiovasc Surg 66(7):390–397

    Article  PubMed  Google Scholar 

  5. Mainwaring RD, Patrick WL, Ma M, Hanley FL (2018) An analysis of patients requiring unifocalization revision following midline unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. Eur J Cardiothorac Surg 54(1):63–70

    Article  PubMed  Google Scholar 

  6. Asija R, Hanley FL, Roth SJ (2013) Postoperative respiratory failure in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals: a pilot study. Pediatr Crit Care Med 14(4):384–389

    Article  PubMed  Google Scholar 

  7. Smith NE, Fabian T, Nabagiez J (2018) Unilateral pulmonary artery atresia in an adult: a case report. Respir Med Case Rep 26:105–107

    PubMed  PubMed Central  Google Scholar 

  8. Meinel FG, Huda W, Schoepf UJ et al (2013) Diagnostic accuracy of CT angiography in infants with tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. J Cardiovasc Comput Tomogr 7(6):367–375

    Article  PubMed  Google Scholar 

  9. Lloyd DFA, Goreczny S, Austin C et al (2018) Catheter, MRI and CT imaging in newborns with pulmonary atresia with ventricular septal defect and aortopulmonary collaterals: quantifying the risks of radiation dose and anaesthetic time. Pediatr Cardiol 39(7):1308–1314

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lin MT, Wang JK, Chen YS et al (2012) Detection of pulmonary arterial morphology in tetralogy of Fallot with pulmonary atresia by computed tomography: 12 years of experience. Eur J Pediatr 171(3):579–586

    Article  PubMed  Google Scholar 

  11. Jia Q, Cen J, Li J et al (2018) Anatomy of the retro-oesophageal major aortopulmonary collateral arteries in patients with pulmonary atresia with ventricular septal defect: results from preoperative CTA. Eur Radiol 28(7):3066–3074

    Article  PubMed  Google Scholar 

  12. Yatsuyanagi E, Sato K, Kikuchi K, Saito H (2014) Pulmonary blood flow measurement using magnetic resonance imaging (MRI) without contrast medium;comparison of phase contrast MRI and perfusion-ventilation scintigraphy. Kyobu Geka 67(2):100–104

    PubMed  Google Scholar 

  13. Kay FU, Beraldo MA, Nakamura MAM et al (2018) Quantitative dual-Energy computed tomography predicts regional perfusion heterogeneity in a model of acute lung injury. J Comput Assist Tomogr 42(6):866–872

    Article  PubMed  PubMed Central  Google Scholar 

  14. Thieme SF, Becker CR, Hacker M, Nikolaou K, Reiser MF, Johnson TR (2008) Dual energy CT for the assessment of lung perfusion–correlation to scintigraphy. Eur J Radiol 68(3):369–374

    Article  PubMed  Google Scholar 

  15. Thieme SF, Johnson TR, Lee C et al (2009) Dual-energy CT for the assessment of contrast material distribution in the pulmonary parenchyma. AJR Am J Roentgenol 193(1):144–149

    Article  PubMed  Google Scholar 

  16. Cai XR, Feng YZ, Qiu L et al (2015) Iodine distribution map in dual-energy computed tomography pulmonary artery imaging with rapid kVp switching for the diagnostic analysis and quantitative evaluation of acute pulmonary embolism. Acad Radiol 22(6):743–751

    Article  PubMed  Google Scholar 

  17. Fuld MK, Halaweish AF, Haynes SE, Divekar AA, Guo J, Hoffman EA (2013) Pulmonary perfused blood volume with dual-energy CT as surrogate for pulmonary perfusion assessed with dynamic multidetector CT. Radiology 267(3):747–756

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhang J, Jiang Y, Rui Q et al (2018) Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI. Medicine (Baltimore) 97(18):e0617

    Article  CAS  Google Scholar 

  19. Lubbers MM, Kock M, Niezen A et al (2018) Iodixanol versus iopromide at coronary CT angiography: lumen opacification and effect on heart rhythm-the randomized IsoCOR trial. Radiology 286(1):71–80

    Article  PubMed  Google Scholar 

  20. Qanadli SD, El Hajjam M, Vieillard-Baron A et al (2001) New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 176(6):1415–1420

    Article  CAS  PubMed  Google Scholar 

  21. Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257(1):158–166

    Article  PubMed  Google Scholar 

  22. Ghoshhajra BB, Lee AM, Engel LC et al (2014) Radiation dose reduction in pediatric cardiac computed tomography: experience from a tertiary medical center. Pediatr Cardiol 35(1):171–179

    Article  PubMed  Google Scholar 

  23. Siemens Healthineers (2019) SOMATOM definition flash. https://static.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@ct/documents/download/mdaw/mzcz/~edisp/ct_ws_somatom_definition_flash_international-00292513.pdf. Accessed February 22, 2019.

  24. De Zordo T, von Lutterotti K, Dejaco C et al (2012) Comparison of image quality and radiation dose of different pulmonary CTA protocols on a 128-slice CT: high-pitch dual source CT, dual energy CT and conventional spiral CT. Eur Radiol 22(2):279–286

    Article  PubMed  Google Scholar 

  25. Siemens Healthineers (2019) SOMATOM force. https://static.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@ct/documents/download/mda4/ndqx/~edisp/di_ct_brochure_somatom_force_brochure_07-2018-05556644.pdf. Accessed February 22, 2019

  26. Abdellatif W, Nicolaou S, Schmiedeskamp H, Powell J (2018) Multifactorial comparative study of dual source CT scanners in acute pulmonary embolism. Paper presented at the 104th annual meeting of the radiological society of North America (RSNA), Chicago, IL, November 26, 2018

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA

    Evan J. Zucker, Aya Kino, Virginia Hinostroza, Dominik Fleischmann & Frandics P. Chan

  2. Siemens Medical Solutions USA, 40 Liberty Boulevard, Malvern, PA, 19355, USA

    Heiko Schmiedeskamp

Authors
  1. Evan J. Zucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aya Kino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heiko Schmiedeskamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Virginia Hinostroza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominik Fleischmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frandics P. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Guarantors of integrity of entire study: E.J.Z.; study concepts/study design: E.J.Z., D.F., F.P.C.; data acquisition or data analysis/interpretation: all authors; manuscript drafting: E.J.Z.; manuscript revision for important intellectual content: all authors; approval of final version of submitted manuscript: all authors.

Corresponding author

Correspondence to Evan J. Zucker.

Ethics declarations

Conflict of interest

E.J.Z., A.K., V.H., D.F., F.P.C.: no relevant relationships. H.S.: employed by Siemens Medical Solutions USA.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study (or their parent/guardian for pediatric subjects less than age 18-years-old).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zucker, E.J., Kino, A., Schmiedeskamp, H. et al. Feasibility and utility of dual-energy chest CTA for preoperative planning in pediatric pulmonary artery reconstruction. Int J Cardiovasc Imaging 35, 1473–1481 (2019). https://doi.org/10.1007/s10554-019-01602-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-019-01602-z

Keywords

Search

Navigation