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      Quantification of Initial Right Ventricular Dimensions by Computed Tomography in Infants with Congenital Heart Disease and a Hypoplastic Right Ventricle

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          Abstract

          Objective

          To demonstrate the feasibility of using cardiothoracic CT for quantification of the initial right ventricle (RV) dimensions in infants with congenital heart disease (CHD) and a hypoplastic RV and to compare these measurements with those obtained in a control group with CHD without a hypoplastic RV.

          Materials and Methods

          Initial RV dimensions, including RV volumes, RV/left ventricle (LV) volume ratios, atrioventricular valve annulus diameter ratios, and RV/LV length ratios based on CT data, were collected from 57 infants with CHD and a hypoplastic RV (hypoplastic RV group; age range, 1 day to 6 months) and 33 infants with tetralogy of Fallot (control group; age range, 1 day to 6 months) and compared between the 2 groups. The type of final surgery was also evaluated in the hypoplastic RV group over a follow-up period of 3–8 years.

          Results

          The RV and LV volumes and lengths were successfully quantified in all 90 patients. The tricuspid valve annulus diameter could not be measured in cases showing muscular tricuspid atresia and double-inlet LV. The initial RV dimensions quantified by CT were significantly lower for the hypoplastic RV group than for the control group ( p < 0.001). The types of final surgery performed in the hypoplastic RV group were univentricular repair in 46 patients, biventricular repair in 4 patients, or an indeterminate surgery in 7 patients.

          Conclusion

          Initial RV dimensions in infants with CHD and a hypoplastic RV can be quantified by CT and are substantially smaller than those in infants with tetralogy of Fallot.

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          Most cited references20

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          State-of-the-Art CT Imaging Techniques for Congenital Heart Disease

          Hyun Goo (2009)
          CT is increasingly being used for evaluating the cardiovascular structures and airways in the patients with congenital heart disease. Multi-slice CT has traditionally been used for the evaluation of the extracardiac vascular and airway abnormalities because of its inherent high spatial resolution and excellent air-tissue contrast. Recent developments in CT technology primarily by reducing the cardiac motion and the radiation dose usage in congenital heart disease evaluation have helped expand the indications for CT usage. Tracheobronchomalacia associated with congenital heart disease can be evaluated with cine CT. Intravenous contrast injection should be tailored to unequivocally demonstrate cardiovascular abnormalities. Knowledge of the state-of-the-art CT imaging techniques that are used for evaluating congenital heart disease is helpful not only for planning and performing CT examinations, but also for interpreting and presenting the CT image findings that consequently guide the proper medical and surgical management.
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            Individualized volume CT dose index determined by cross-sectional area and mean density of the body to achieve uniform image noise of contrast-enhanced pediatric chest CT obtained at variable kV levels and with combined tube current modulation.

            Hyun Goo (2011)
            A practical body-size adaptive protocol providing uniform image noise at various kV levels is not available for pediatric CT. To develop a practical contrast-enhanced pediatric chest CT protocol providing uniform image noise by using an individualized volume CT dose index (CTDIvol) determined by the cross-sectional area and density of the body at variable kV levels and with combined tube current modulation. A total of 137 patients (mean age, 7.6 years) underwent contrast-enhanced pediatric chest CT based on body weight. From the CTDIvol, image noise, and area and mean density of the cross-section at the lung base in the weight-based group, the best fit equation was estimated with a very high correlation coefficient (γ(2) = 0.86, P 0.05). Contrast-enhanced pediatric chest CT with the CTDIvol determined individually by the cross-sectional area and density of the body provides more uniform noise and better dose adaptation to body habitus than does weight-based CT at variable kV levels and with combined tube current modulation.
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              User-Friendly Vendor-Specific Guideline for Pediatric Cardiothoracic Computed Tomography Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 1. Imaging Techniques

              Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.
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                Author and article information

                Journal
                Korean J Radiol
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                February 2020
                06 January 2020
                : 21
                : 2
                : 203-209
                Affiliations
                Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
                Author notes
                Corresponding author: Hyun Woo Goo, MD, PhD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: (822) 3010-4388, Fax: (822) 476-0090, ghw68@ 123456hanmail.net
                Author information
                https://orcid.org/0000-0001-6861-5958
                Article
                10.3348/kjr.2019.0662
                6992442
                31997595
                1c17ab40-9ee3-4999-981e-a8123a2df7b3
                Copyright © 2020 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 September 2019
                : 31 October 2019
                Categories
                Cardiovascular Imaging
                Original Article

                Radiology & Imaging
                atrioventricular septal defect,cardiothoracic ct,congenital heart disease,hypoplastic right ventricle,pulmonary atresia with intact ventricular septum,right ventricular dimension

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