Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants

 

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Abstract

Purpose To evaluate the sensitivity, specificity, and interobserver reliability of high-pitch dual-source computed tomography angiography (CTA) in the detection of anomalous pulmonary venous connection (APVC) in infants with congenital heart defects and to assess the associated radiation exposure.

Materials and Methods 78 pulmonary veins in 17 consecutively enrolled patients with congenital heart defects (6 females; 11 males; median age: 6 days; range: 1–299 days) were retrospectively included in this study. All patients underwent high-pitch dual-source CTA of the chest at low tube voltages (70 kV). APVC was evaluated independently by two radiologists. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interobserver agreement were determined. For standard of reference, one additional observer reviewed CT scans, echocardiography reports, clinical reports as well as surgical reports. In cases of disagreement the additional observer made the final decision based on all available information.

Results Detection of APVC with high-pitch dual-source CTA revealed a good sensitivity (91 %) and specificity (99 %), with PPV and NPV of 98 % and 97 %. Interobserver agreement was almost perfect (Kappa = 0.84). The median DLP was 3.8 mGy*cm (IQR 3.3–4.7 mGy*cm) and the median radiation dose was 0.33 mSv (IQR 0.26–0.39 mSv).

Conclusion High-pitch dual-source CTA in infants with congenital heart defects allows for accurate and reliable assessment of APVC at a low radiation dose.

Key Points: 

• High-pitch dual-source CTA enables detection of anomalous pulmonary vein connection with high sensitivity in infants.

• Interrater reliability in the detection of anomalous pulmonary vein connection with high-pitch dual-source CTA is almost perfect.

• Radiation dose of high-pitch dual-source CTA in the cardiac examination of infants is low.

Citation Format

• Well L, Weinrich JM, Meyer M et al. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. Fortschr Röntgenstr 2021; 193: 551 – 558

Zusammenfassung

Ziel Bewertung der Sensitivität, Spezifität und Interrater-Reliabilität der High-Pitch-Dual-Source-Computertomografie-Angiografie (CTA) in der Detektion von Pulmonalvenenfehlmündungen bei Säuglingen mit angeborenen Herzfehlern und Bewertung der damit verbundenen Strahlenbelastung.

Material und Methoden In diese retrospektive Studie wurden 78 Lungenvenen aus 17 konsekutiv untersuchten Säuglingen mit angeborenen Herzfehlern eingeschlossen (6 Mädchen, 11 Jungen; Medianalter 6 Tage, Range 1–299 Tage). Bei allen Patienten wurde eine High-Pitch-Dual-Source-CTA des Thorax bei niedriger Röhrenspannung (70 kV) durchgeführt. Das Vorliegen von Pulmonalvenenfehlmündungen wurde von 2 Radiologen unabhängig voneinander bewertet. Sensitivität, Spezifität, positive (PPV) und negative prädiktive Vorhersagewerte (NPV) sowie die Interrater-Reliabilität wurden bestimmt. Als Referenzstandard diente die Kombination aus CT-Scans, Befunden der Echokardiografie, klinischen Berichten sowie Operationsberichten, die von einem erfahrenen Kinderradiologen in Zusammenschau ausgewertet wurden. Dieser entschied im Fall inkongruenter Befunde über die korrekte Interpretation.

Ergebnisse Die Detektion von Pulmonalvenenfehlmündungen mit der High-Pitch-Dual-Source-CTA gelang mit guter Sensitivität (91 %) und Spezifität (99 %), bei PPV und NPV von 98 % und 97 %. Die Interrater-Reliabilität war nahezu perfekt (Kappa = 0,84). Der Median des DLP betrug 3,8 mGy*cm (IQR 3,3–4,7 mGy*cm), die effektive Dosis betrug im Median 0,33 mSv (IQR 0,26–0,39 mSv).

Schlussfolgerung Die High-Pitch-Dual-Source-CTA bei Säuglingen mit angeborenen Herzfehlern ermöglicht eine genaue und zuverlässige Detektion von Lungenvenenfehlmündungen bei niedriger Strahlendosis.

Kernaussagen: 

• Die High-Pitch-Dual-Source-CTA ermöglicht die Detektion von Pulmonalvenenfehlmündungen bei Säuglingen mit hoher Sensitivität.

• Die Interrater-Reliabilität bei der Erkennung von Pulmonalvenenfehlmündungen mit High-Pitch-Dual-Source-CTA ist hoch.

• Die Strahlendosis der High-Pitch-Dual-Source-CTA bei der kardialen Untersuchung von Säuglingen ist gering.

Publication History

Received: 12 June 2020

Accepted: 29 September 2020

Article published online:
10 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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