Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease

OBJECTIVE. The purpose of our study was to determine the value of three-dimensional reconstructed helical CT in the assessment of the pulmonary arteries in infants and children with complex congenital heart disease. MATERIALS AND METHODS. Twenty patients were examined with contrast-enhanced helical CT. Three-dimensional reconstructions were performed with multiplanar reformations, maximum intensity projection, and shaded-surface display. Correlation was made with 19 echocardiograms and 14 cineangiocardiograms. All imaging studies were reviewed independently for the following parameters: the caliber of the main and branch pulmonary arteries and their confluence, the presence of stenosis, the number and caliber of aortopulmonary collaterals, and the patency of vascular shunts and conduits. Surgical confirmation, which was used as the reference standard, was available in all patients. RESULTS. Helical CT was as accurate as angiocardiography in revealing stenotic and nonconfluent central pulmonary arteries and in revealing aortopulmonary collaterals (overall CT test parameters: sensitivity, 90%; specificity, 100%; accuracy, 93%). Three-dimensional rendition did not improve the accuracy of CT. The patency of shunts was shown equally well with CT as with angiography, but CT showed thrombosis more directly. Echocardiography was the least accurate technique in revealing pulmonary artery anatomy (accuracy, 65%), primarily because a relatively large number of studies were technically unsatisfactory to assess the study parameters. CONCLUSION. Helical CT angiocardiography with three-dimensional reconstruction is superior to echocardiography for the noninvasive assessment of pulmonary artery anatomy in patients with complex congenital heart disease. Helical CT may be used as a complementary technique and occasionally as a substitute for the diagnostic imaging portion of cardiac catheterization with cineangiocardiography.