Radiology of Anomalies of Pulmonary Veins

A study of 43 cases of suspected congenital diseases of heart was performed in Sahyadri Hospital, Pune, over a period of 5 to 6 years with dual source computed tomography (CT) in adolescents as well as children. Only the images of anomalies of pulmonary veins are presented.Compared with different radiological techniques, CT offers many advantages, as it can be undertaken even in neonates, yields more information than MR in a very little time, is better than 2D echo, when there is a small inter-costal window in some infants and is noninvasive. This study proved useful for further medical/surgical management.

Application value of preoperative dual-source computed tomography in assessing the rupture site of thoracic aortic dissection

Objective To investigate the application value of dual-source computed tomography (DSCT) in preoperative assessment the rupture site of an thoracic aortic dissection (TAD). Methods A retrospective analysis of preoperative DSCT, multislice computed tomography (MSCT), and transthoracic echocardiography (TTE) results of 150 patients with suspected TAD in our hospital was conducted, and the intraoperative findings or interventional treatment results were used as the diagnostic gold standard. Results Of all 150 suspected TAD patients, 123 patients were confirmed to have TAD. The rupture site of TAD was in the ascending aorta in 46 patients, in the aortic arch in 13 patients, and in the descending aorta in 64 patients. The sensitivity of DSCT, MSCT, and TTE for locating the rupture site of the TAD was 100%, 93.5%, and 89.5%, respectively, and the specificity was 100%, 88.9%, and 81.5%. The differences were statistically significant. The distance between the actual rupture site and the one diagnosed by DSCT, MSCT, and TTE was 1.9 ± 1.2 mm, 5.1 ± 2.7 mm, and 7.8 ± 3.5 mm, respectively; the latter two were significantly worse than DSCT. The size of the rupture site diagnosed by DSCT, MSCT, and TTE was 1.5 ± 0.8 cm, 1.7 ± 0.9 cm, and 1.9 ± 1.0 cm, respectively. The size of the rupture site diagnosed by DSCT was not significantly different from the actual size of 1.4 ± 0.7 cm, while those by MSCT and TTE were. Conclusion DSCT has high sensitivity and specificity in diagnosing the rupture site of TAD and can clearly locate the rupture site. It can be a preferred imaging method for TAD.

Assessment of Intracardiac and Extracardiac Anomalies in Patients with Various Types of Pulmonary Atresia by Low-dose Dual-source Computed Tomography

Background: pulmonary atresia (PA) is a group of heterogeneous complex congenital heart disease which need more than one study modality to get correct diagnoses. This study aims to investigate the diagnostic power of low-dose dual-source computed tomography (DSCT) for all intracardiac and extracardiac anomalies in patients with PA compared with transthoracic echocardiography (TTE).Materials and methods: This retrospective study enrolled 73 patients and divided them into three groups according to their main diagnosis. All associated malformation and clinical information, including treatments, were recorded and compared among the three groups. The diagnostic power of DSCT and TTE on all associated anomalies were compared. The surgical index (McGoon ratio, pulmonary arterials index (PAI), and total neopulmonary arterial index) and radiation dose were calculated on the basis of DSCT.Results: Of the patients, 29, 29, and 15 were divide into the groups of PA with ventricular septal defect (VSD), PA with VSD and major aortopulmonary collateral arteries, and PA with other major malformations, respectively. Consequently, 178, 144, and 12 intracardiac, extracardiac, and other major anomalies were diagnosed, respectively. Moreover, DSCT showed a better diagnostic performance in extracardiac anomalies (137 vs 100, p = 0.000), whereas TTE could diagnose intracardiac anomalies better (158 vs 134, p = 0.001). The McGoon ratio, PAI, and treatment methods were significantly different among the three groups (p = 0.027, p = 0.035, and p = 0.041, respectively).Conclusion: More than one imaging modality should be used to make a correct diagnosis when clinically suspecting PA. DSCT is superior to TTE in diagnosing extracardiac anomalies and could be used to roughly calculate surgical indices to optimize treatment strategy.

Low-Dose Dual-Source Computed Tomography for Evaluating Persistent Truncus Arteriosus Associated with Cardiovascular Anomalies: Comparison with Transthoracic Echocardiography

BackgroundTo assess the morphological features of persistent truncus arteriosus (PTA) on low-dose dual-source computed tomography (DSCT) and compare its diagnostic value for associated cardiovascular anomalies with that of transthoracic echocardiography (TTE).Methods:Twenty-four PTA patients were enrolled in this retrospective study. The types of PTA, diameters of the truncus artery (TA), main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and ventricular septal defect (VSD) on DSCT were recorded. Besides, all associated cardiovascular abnormalities were assessed. The diagnostic performance of DSCT and TTE for associated anomalies were compared. The effective doses of DSCT were calculated.Results:Four types were found: type A1(n=13/24, 54.17%), type A2(n=7/24, 29.16%), type A3（n=3/24, 12.50%）and type A4(n=1/24,4.17%). The mean diameter of VSD, TA, MPA, RPA, and LPA was 1.47±0.56cm, 3.92±1.56cm, 2.27±1.65cm, 1.48±0.74cm and 1.38±0.66cm, respectively. 78 associated cardiovascular anomalies were confirmed. The most common associated abnormalities were VSD (100%), right-sided aortic arch (33.33%) and aortopulmonary collateral vessels (29.17%). Although TTE was better at diagnosing intracardiac anomalies (accuracy:99.17% vs. 95%; sensitivity: 97.06% vs. 88.24%; specificity: 100% vs. 97.67%), DSCT had an advantage in diagnosing the associated cardiovascular abnormalities (accuracy: 98.61% vs. 96.07%; sensitivity: 94.87% vs. 82.05%; specificity: 99.44% vs. 99.15%). The estimated mean effective doses was 0.98±0.37mSv (＜1mSv). Conclusions:Low-dose DSCT could accurately confirm the morphological features of PTA. Compared to TTE, low-dose DSCT is a better diagnostic tool for associated cardiovascular abnormalities. Combining with TTE will be beneficial to provide more accurate information for clinical interventions.

Lung Volume Determination by Dual-source Computed Tomography in Infants with Pulmonary Artery Sling

Background: Pulmonary artery sling (PAS) is associated with tracheal stenosis and left pulmonary artery (LPA) dysplasia in infants, which may cause pulmonary dysplasia and lung volume variations. We aimed to assess these altered lung volumes in patients with PAS using dual-source computed tomography (DSCT). Methods: We retrospectively enrolled patients with surgically confirmed PAS and compared them with matched normal controls. All participants underwent DSCT examination. We measured and compared the diameters of the trachea, main bronchus and main pulmonary artery (MPA) and its branches and both lung volumes on axial and reconstructed computed tomography images. Results: There were no statistical differences in the diameters of MPA or right pulmonary artery between patients and controls. The diameters of the stenosed trachea , left and right main bronchi and LPA were smaller in the PAS group than in the control group (p < 0.001) , and significant differences were evident in the left lung volume (p < 0.001), right lung volume (p = 0.008) and the right-to-left lung volume ratio (p = 0.004) between the two groups. Pearson’s correlation and linear regression analyses between the diameters of the trachea and MPA, total lung volume, ipsilateral bronchial and pulmonary artery branches and ipsilateral lung volume ranged from 0.71 to 0.87 (p < 0.001) and 0.57 to 0.77 (p < 0.05) for the control and PAS groups, respectively. Conclusions: Lung development is disordered in patients with PAS, which causes not only tracheal stenosis and LPA dysplasia but also dysplasia of both lungs.