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

OBJECTIVE. The purpose of our study was to determine the value of three-dim ensional reconstructed helical CT in the assessment of the pulmonary arteri es 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 multipla nar 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 parameter s: the caliber of the main and branch pulmonary arteries and their confluen ce, the presence of stenosis, the number and caliber of aortopulmonary coll aterals, and the patency of vascular shunts and conduits. Surgical confirma tion, which was used as the reference standard, was available in all patien ts. RESULTS. Helical CT was as accurate as angiocardiography in revealing steno tic and nonconfluent central pulmonary arteries and in revealing aortopulmo nary collaterals (overall CT test parameters: sensitivity, 90%; specificity , 100%; accuracy, 93%). Three-dimensional rendition did not improve the acc uracy of CT. The patency of shunts was shown equally well with CT as with a ngiography, but CT showed thrombosis more directly. Echocardiography was th e least accurate technique in revealing pulmonary artery anatomy (accuracy, 65%), primarily because a relatively large number of studies were technica lly unsatisfactory to assess the study parameters. CONCLUSION. Helical CT angiocardiography with three-dimensional reconstruct ion is superior to echocardiography for the noninvasive assessment of pulmo nary artery anatomy in patients with complex congenital heart disease. Heli cal CT may be used as a complementary technique and occasionally as a subst itute for the diagnostic imaging portion of cardiac catheterization with ci neangiocardiography.