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      Use of Cardiac Computed Tomography for Ventricular Volumetry in Late Postoperative Patients with Tetralogy of Fallot

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          Abstract

          Background

          Cardiac computed tomography (CT) has emerged as an alternative to magnetic resonance imaging (MRI) for ventricular volumetry. However, the clinical use of cardiac CT requires external validation.

          Methods

          Both cardiac CT and MRI were performed prior to pulmonary valve implantation (PVI) in 11 patients (median age, 19 years) who had undergone total correction of tetralogy of Fallot during infancy. The simplified contouring method (MRI) and semiautomatic 3-dimensional region-growing method (CT) were used to measure ventricular volumes.

          Results

          All volumetric indices measured by CT and MRI generally correlated well with each other, except for the left ventricular end-systolic volume index (LV-ESVI), which showed the following correlations with the other indices: the right ventricular end-diastolic volume index (RV-EDVI) (r=0.88, p<0.001), the right ventricular end-systolic volume index (RV-ESVI) (r=0.84, p=0.001), the left ventricular end-diastolic volume index (LV-EDVI) (r=0.90, p=0.001), and the LV-ESVI (r=0.55, p=0.079). While the EDVIs measured by CT were significantly larger than those measured by MRI (median RV-EDVI: 197 mL/m 2 vs. 175 mL/m 2, p=0.008; median LV-EDVI: 94 mL/m 2 vs. 92 mL/m 2, p=0.026), no significant differences were found for the RV-ESVI or LV-ESVI.

          Conclusion

          The EDVIs measured by cardiac CT were greater than those measured by MRI, whereas the ESVIs measured by CT and MRI were comparable. The volumetric characteristics of these 2 diagnostic modalities should be taken into account when indications for late PVI after tetralogy of Fallot repair are assessed.

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          Most cited references9

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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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            Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance.

            Cardiac magnetic resonance (CMR) accurately quantifies right ventricular (RV) and left ventricular (LV) volumes and function. Limited availability of CMR and increasing use of MR-incompatible cardiovascular devices underscore the potential utility of cardiac computed tomography (CT) for ventricular quantification. This study quantified biventricular size and systolic function with multi-detector row CT compared with CMR imaging. Twenty-six subjects prospectively underwent CT and CMR examinations on a 16-detector CT and 1.5 T MR scanner, respectively; claustrophobia in one and nongated CT imaging in another precluded complete imaging in 2 subjects. Contiguous multiphase short-axis images were generated from axial CT data, and steady-state free precession cine MR produced contiguous short-axis cines. Semiautomated software generated ventricular borders to calculate volume, mass, and ejection fraction (EF) from both sets of images. Blinded observers completed quantification and wall motion analyses of 23 CMR and CT data sets independently. All measures of LV size and function by cardiac CT correlated well with CMR over a wide range of LV function (LVEF 30%-72% by CMR), including end-diastolic volume (r = 0.97), end-systolic volume (r = 0.97), EF (r = 0.97), and mass (r = 0.95). Of 24 cases, 6 had inadequate contrast opacification of the RV precluding RV segmentation. In the remaining 18 CMR-CT data pairs, RVEF showed moderate agreement (r = 0.86), and RV volumes correlated well (r = 0.97 and 0.94 for RV end-diastolic volume and RV end-systolic volume, respectively). Ten percent of LV segments visualized by CT were inadequate for wall motion assessment due to motion artifact or inadequate contrast between myocardium and endocardium. For segments adequately visualized by both techniques, the mean kappa statistic was 0.88 (range 0.78-1.0), consistent with good agreement. Cardiac CT accurately quantifies LV size and function; RV quantification with cardiac CT requires optimized contrast opacification of the RV.
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              Accuracy of multi-slice computed tomography for measurement of left ventricular ejection fraction compared with cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography: a systematic review and meta-analysis.

              Multi-slice computed tomography (MSCT) allows non-invasive assessment of the coronary arteries and simultaneously can provide measurement of left ventricular ejection fraction (LVEF). The accuracy of newer MSCT generations (64-slice or more) for assessment of LVEF compared with magnetic resonance imaging (MRI) and two-dimensional transthoracic echocardiography (TTE) has not been evaluated in a meta-analysis.
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                Author and article information

                Journal
                Korean J Thorac Cardiovasc Surg
                Korean J Thorac Cardiovasc Surg
                The Korean Journal of Thoracic and Cardiovascular Surgery
                The Korean Society for Thoracic and Cardiovascular Surgery
                2233-601X
                2093-6516
                April 2017
                05 April 2017
                : 50
                : 2
                : 71-77
                Affiliations
                [1 ]Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine
                [2 ]Department of Diagnostic Imaging, Asan Medical Center, University of Ulsan College of Medicine
                Author notes
                Corresponding author: Tae-Jin Yun, Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea, (Tel) 82-2-3010-3589, (Fax) 82-2-3010-6811, (E-mail) tjyun@ 123456amc.seoul.kr
                Article
                kjtcvs-50-071
                10.5090/kjtcs.2017.50.2.71
                5380198
                a0cc47f4-9df1-457a-b288-eea32666d3bc
                Copyright © 2017 by The Korean Society for Thoracic and Cardiovascular Surgery. All rights Reserved.

                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
                : 23 June 2016
                : 21 September 2016
                : 17 October 2016
                Categories
                Clinical Research

                Surgery
                congenital heart disease,ventricular volumetry,cardiac computed tomography,cardiac magnetic resonance imaging

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