Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting.

2020

2020 Jan 20

1522-726X

<p>Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock-Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0-12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.</p>

10.1002/ccd.28735

Catheter Cardiovasc Interv

31957932

Diagnostic performance of CT angiography to detect pulmonary vein stenosis in children.

2019

2019 Sep 09

1875-8312

<p>To assess the diagnostic efficiency of CT angiography (CTA) to detect pulmonary vein stenosis in children. We retrospectively identify patients between 0 and 3&nbsp;years old with confirmed pulmonary vein stenosis with conventional angiography or surgery and available CTA. Patients without confirmed stenosis of the pulmonary veins were included as controls. We excluded patients with previous surgery involving the pulmonary veins, exclusively right-heart conventional angiography or insufficient data in the operation note to confirm the status of the pulmonary veins. Two pediatric radiologists evaluated and determine the presence of stenosis and the pulmonary veins affected. Disagreement between the readers were solved by consensus with a third reader. A pediatric cardiologist reviewed the available angiographic images to determine the presence of stenosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Kappa statistics was performed. 26 patients (15 boys, 11 Girls) were included. Conventional angiography (n = 20) and cardiothoracic surgery (n = 6) confirmed the diagnosis of pulmonary vein stenosis in 13 children. The diagnostic performance at patient level showed the sensitivity, specificity, PPV, and NPV were 84.6%, 92.3%, 91.6%, 87.5%, and 88.4%, respectively. The interobserver was k = 0.76. The performance at pulmonary vein level showed the sensitivity, specificity, PPV, and NPV were 63.3%, 97.4%, 90.4%,85.7% and 87.9%, respectively. The interobserver agreement was k = 0.62. Computed Tomography Angiography is an excellent and reliable image technique for ruling in pulmonary vein stenosis in young children.</p>

10.1007/s10554-019-01693-8

Int J Cardiovasc Imaging

31502067

Contrast Extravasation using Power Injectors for Contrast-Enhanced Computed Tomography in Children: Frequency and Injury Severity.

2019

2019 May 25

1878-4046

<p><strong>PURPOSE: </strong>To evaluate the safety of power injectors for contrast-enhanced computed tomography (CT) in children, namely: the prevalence and injury severity of contrast extravasations related to power injectors and the factors associated with these events.</p>

<p><strong>METHODS: </strong>The need to obtain informed consent was waived for this HIPAA-compliant and IRB approved retrospective study. Around 2429 contrast-enhanced CT performed with a power injector were identified during a 3-year period. Data collected included patient demographic, power injector, and contrast agent information. The patients' symptoms, severity of injury and treatment with contrast extravasation were recorded. Around 1496 cases (823 boys, 673 girls) were included in the analysis. Independent-sample t test and Chi-square were used. For a sub-analysis using the extravasation cases, nonparametric tests were used.</p>

<p><strong>RESULTS: </strong>The mean age was 9.5 ± 6.1 years. The most common access site, catheter site, and contrast agent used were the antecubital fossa, 22 gauge and Iohexol. The mean peak pressure was 68.9 ± 62.3 psi and the flow rate was 1.7 ± 0.9 mL/s. Eighteen cases of contrast extravasation were identified with a mean age of 11.2 ± 6.2 years. There were seven mild, six moderate, and five severe. Cases with extravasation had significantly higher peak pressure (p &lt; 0.001) and flow rate (p &lt; 0.001) compared to those without extravasation. Patients who received Iohexol-350 had significantly more contrast extravasation compared to those who used Iohexol-300 (p = 0.03). However, after post-hoc correction, only peak pressure (p &lt; 0.01) and flow rate (p = 0.01) remained significant.</p>

<p><strong>CONCLUSION: </strong>The use of power injectors in children undergoing contrast-enhanced CT is associated with a low rate of extravasation and of long-term injury.</p>

10.1016/j.acra.2019.04.008

Acad Radiol

31138458

MRI Evaluation of Lymphatic Abnormalities in the Neck and Thorax after Fontan Surgery: Relationship with Outcome.

2019

180877

2019 Apr 02

1527-1315

<p>Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine if the degree of neck and thoracic lymphatic abnormalities at T2-weighted MRI in patients after superior cavopulmonary connection (SCPC) correlated with surgical outcomes from the Fontan procedure. Materials and Methods Patients for whom SCPC was performed for palliation of single ventricle disease who underwent chest MRI between July 2012 and May 2015 at a single institution were retrospectively reviewed. T2-weighted images were scored as lymphatic type 1 (little or no T2 mediastinal and supraclavicular signal) to type 4 (T2 signal into both the mediastinum and the lung parenchyma). Fontan takedown, duration of post-Fontan hospitalization and pleural effusion, postoperative plastic bronchitis, need for transplant, and mortality were tabulated. The relationship between lymphatic type and clinical outcomes was evaluated by using analysis of variance (ANOVA), the Kruskal-Wallis H test, and the Fisher exact test. Results A total of 83 patients (mean age, 7.9 years ± 2.6) were evaluated. Among these 83 patients, 53 (64%) were classified with type 1 or 2 lymphatic abnormalities, 17 (20%) with type 3, and 12 (16%) with type 4. The rate of failure of Fontan completion was higher in patients with type 4 than in type 1 or 2 (54% vs 2%, respectively; P = .004). Need for cardiac transplant (one of 13 [8%]) and death (three of 13 [23%]) occurred only in type 4. Median postoperative length of stay was longer for patients with type 4 than for those with types 1 or 2 (29 days vs 9 days, respectively; P &lt; .01). Conclusion Greater MRI-based severity of lymphatic abnormalities in patients prior to planned Fontan procedure was associated with failure of Fontan completion and longer postoperative stay. © RSNA, 2019 Online supplemental material is available for this article.</p>

10.1148/radiol.2019180877

Radiology

30938628

Intrahepatic dynamic contrast MR lymphangiography: initial experience with a new technique for the assessment of liver lymphatics.

2019

2019 Mar 18

1432-1084

<p><strong>OBJECTIVES: </strong>To describe the technique and report on our initial experience with the use of intrahepatic dynamic contrast magnetic resonance lymphangiography (IH-DCMRL) for evaluation of the lymphatics in patients with hepatic lymphatic flow disorders.</p>

<p><strong>METHODS: </strong>This is a retrospective review of the imaging and clinical findings in six consecutive patients undergoing IH-DCMRL. The technique involves injection of a gadolinium contrast agent into the intrahepatic lymphatic ducts followed by imaging of the abdomen and chest with both heavily T2-weighted imaging and dynamic time-resolved imaging.</p>

<p><strong>RESULTS: </strong>In six consecutive patients, IH-DCMRL was technically successful. There were four patients with protein-losing enteropathy (PLE) and two with ascites in this study. In the four patients with PLE, IH-DCMRL demonstrated hepatoduodenal connections with leak of contrast into the duodenal lumen not seen by conventional lymphangiography. In one patient with ascites, IH-DCMRL demonstrated lymphatic leakage into the peritoneal cavity not seen by intranodal lymphangiography. In the second patient with ascites, retrograde lymphatic perfusion of mesenteric lymphatic networks and nodes was seen. Venous contamination was seen in two patients. No biliary contamination was identified. There were no short-term complications.</p>

<p><strong>CONCLUSIONS: </strong>IH-DCMRL is a cross-sectional technique which successfully evaluated hepatic lymphatic flow disorders and warrants further investigation.</p>

<p><strong>KEY POINTS: </strong>• Intrahepatic dynamic contrast magnetic resonance lymphangiography (IH-DCMRL) is a new imaging technique to evaluate hepatic lymphatic flow disorders such as protein-losing enteropathy. • In comparison to conventional liver lymphangiography, IH-DCMRL offers a 3D imaging technique and better distal lymphatic contrast distribution and does not use ionizing radiation.</p>

10.1007/s00330-019-06112-z

Eur Radiol

30887210

Image quality and radiation dose of ECG-triggered High-Pitch Dual-Source cardiac computed tomography angiography in children for the evaluation of central vascular stents.

2019

2019 Jan 25

1875-8312

<p>Assess image quality and radiation dose of ECG-triggered High-Pitch Dual-Source CTA for the evaluation central vascular stents in children. We included all children ≤ 21&nbsp;years old with one or more central vascular stents and available prospective ECG-triggered High-Pitch Dual-Source CTA performed at our institution between January 2015 and August 2017. Demographic and scanner information was retrieved. Two board-certified pediatric radiologists blinded to the clinical data, independently reviewed and scored each case using a four-point quality score. Scores 1, 2 and 3 were considered of diagnostic image quality. Inter-observer agreement and non-parametric test were used. 18 patients (10 girls, 8 boys) with a mean age of 9.47 ± 7.38&nbsp;years (mean ± SD) met inclusion criteria. Thirty-two central vascular stents were evaluated. Mean quality score was 2.07 ± 0.94 with 12.5% (4/32) of the cases classified as unevaluable. Interobserver agreement was excellent (k = 0.86). There is no significant difference between quality score and stent location (p = 0.07). There is a significant difference with stent material as all non-diagnostic scores were only seen in covered stents made of platinum-iridium (p &lt; 0.001). There was no association between image quality and age, height, weight, BSA, heart rate, radiation dose or stent lumen size (p &gt; 0.05). ECG-triggered high-pitch spiral DS-CTA offers appropriate image quality for assessment of central vascular stents in children.</p>

10.1007/s10554-019-01539-3

Int J Cardiovasc Imaging

30684082

Image Quality of ECG-Triggered High-Pitch, Dual-Source Computed Tomography Angiography for Cardiovascular Assessment in Children.

2018

2018 Oct 29

1535-6302

<p><strong>PURPOSE: </strong>Evaluate the feasibility and determinants of image quality of ECG-triggered High-Pitch Dual-Source Computed Tomography Angiography (CTA) for cardiovascular assessment in Children.</p>

<p><strong>MATERIAL AND METHODS: </strong>All children that underwent ECG-triggered High-Pitch Dual-Source CTA between August 2014 and September 2017 were identified. Scanner parameters and patients' information were retrieved. Objective image quality was evaluated measuring the Hounsfield units (HU) and standard deviation of regions of interests in the left ventricle, ascending and descending aorta. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Qualitative image quality was recorded independently by two pediatric radiologist blinded using a three-point scale: 1 - good image quality, 2 - mild artifacts, 3 - poor image quality. Continuous variables were presented as mean ± standard deviation. The interobserver agreement and non-parametric test were used.</p>

<p><strong>RESULTS: </strong>93 patients (mean age 5.6 ± 7.1 years) were selected. Average cardiovascular attenuation, SNR and CNR were 406.2 ± 146.3 HU, 24.2 ± 16.0 HU and 52.1 ± 38.6 HU, respectively. Average image quality was 1.51 ± 0.48 and the inter-observer agreement was excellent (k = 0.8). Worse subjective quality scores were associated with lower age, height, weight, BSA, lower contrast dose and slower injection rates (p &lt; 0.05). Higher heart rate was associated with high attenuation (p &lt; 0.05), however, SNR and CNR did not show an association with heart rate (p = 0.80).</p>

<p><strong>CONCLUSIONS: </strong>ECG-triggered High-Pitch Dual-Source cardiac CTA is feasible and provides good or excellent image quality for the evaluation of cardiovascular diseases in children.</p>

10.1067/j.cpradiol.2018.10.006

Curr Probl Diagn Radiol

30472138

Depiction of the native coronary arteries during ECG-triggered High-Pitch Dual-Source Coronary Computed Tomography Angiography in children: Determinants of image quality.

2018

240-245

2018 Aug 18

1873-4499

<p><strong>OBJECTIVE: </strong>Assess the image quality of ECG-triggered High-Pitch Dual-Source CTA for the evaluation of native coronaries in children.</p>

<p><strong>MATERIALS AND METHODS: </strong>Between August 2014 and September 2017, 45 children with morphologically normal cardiac chambers had cardiac prospective ECG-triggered High-Pitch Dual-Source CTA. Two pediatric radiologists blinded to clinical data, independently reviewed each case. The coronary arteries were evaluated using a four-point scale quality score according to the coronary segment. Attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured using values from the air, inter-ventricular septum and ascending aorta at the level of the sinuses of Valsalva.</p>

<p><strong>RESULTS: </strong>225 coronary segments were assessed showed a mean score of 2.40 ± 0.73, 94.2% had diagnostic image quality. The best and worst average quality were seen in segment 5 and 2, respectively. Inter-observer agreement was moderate for all segments except for segment 1, which was excellent. Worse quality scores were significantly associated with younger patients and low body mass index as well as with higher heart rates in all segments. The mean observed heart rate and BSA in patients with diagnostic image quality were below 77 bpm and over 1.4 m respectively. There is no significant association between attenuation, SNR and CNR with image quality.</p>

<p><strong>CONCLUSIONS: </strong>Prospective ECG-triggered High-Pitch Dual-Source Computed Tomography Angiography achieves consistent and diagnostic image quality for coronary artery assessment at a low effective dose in pediatric patients.</p>

10.1016/j.clinimag.2018.08.013

Clin Imaging

30142610