Cardiac CT or MRI in pediatric practice: Which one to choose?

Abstract

The different factors involved in the choice of the best cardiovascular imaging examination for pediatric patients are justification, radiation protection, sedation, resolutions (spatial and contrast), morphology or function, intervention and contrast enhancement. Computed tomography is preferable for all coronary artery conditions, any arterial or venous abnormalities in newborns and infants and in the preoperative assessment for tetralogy of Fallot. Magnetic resonance imaging is used for any tumoral or functional assessment, cardiomyopathy or arrhythmia or if the child's participation and/or size of the structures being examined allows using this technique.

Three-dimensional printing models in congenital heart disease education for medical students: a controlled comparative study

“…Computed tomography (CT) images and cardiac magnetic resonance imaging (MRI) were used as source data for printing the high-fidelity models. Compared to MRI, CT provides superior spatial resolution [ 22 ] but radiation is an inevitable shortage. Both of them as image source are limited and some researchers [ 11 ] have developed an approach to utilizing echocardiographic images as source data to enhance fidelity of heart models, especially for valve anatomy.…”

Clinical Applications of Late Gadolinium in Children

“…Lake Louise Consensus criteria include three CMR features for improving diagnostic accuracy: 1) increased regional or global signal on T2-weighted images; 2) increased early gadolinium enhancement ratio (between myocardium and skeletal muscle), 3) one or more focal lesions of LGE without an ischemic distribution. The fulfilment of two or more criteria have a diagnostic accuracy can of 78-85% compared with endomyocardial biopsy [7]. Moreover, the segmental distribution of LGE findings can aid for a successful subsequent endomyocardial biopsy, and there is a good diagnostic agreement between CMR and endomyocardial biopsy for the diagnosis of myocarditis.…”

“…When LGE is seen (30% in adults), the typical pattern is in form of linear stripes and patches in the basal to midventricular regions in a non-vascular distribution (non-ischemic pattern) (14,20). In children, LGE has been showed in only 16% possibly due to a different repair mechanism for fibrosis in children that enables favourable reverse remodelling [4,7,9].…”

“…Cardiac involvement presents with concentric HCM, heart failure and arrhythmias. Distinguishing Fabry disease from HCM (up to 6% of suspected HCM are Anderson-Fabry disease) is important because the former is managed by enzyme replacement therapy with improvement in LV function, and the latter by pharmacological therapy/surgery/ICD [4,7,9].…”

“…The presence of LGE in patients with HCM has an important prognostic significance, since it has been reported as an increased risk for sudden cardiac death, systolic dysfunction and non-sustained ventricular tachycardia compared with patients without LGE in CMR. Therefore LGE sequence may have an important role in improving the risk assessment in borderline or controversial cases benefiting from ICD [6,7].…”