Intermodality agreement between TTE and low kVp ECG-gated MDCTA in diagnosis of complex CHD in pediatrics

Abstract

Background Transthoracic echocardiography (TTE) is considered the primary diagnostic modality in congenital heart disease (CHD). However, it has limited role in evaluation of extra-cardiac major vessels abnormalities. Cardiac catheterization angiography is considered the gold standard investigation, yet, it is invasive. The aim of this study is to evaluate the agreement between TTE and low kVp ECG-gated cardiac multi-detector CT angiography (MDCTA) in detecting cardiac and extra-cardiac findings of complex congenital heart disease in a sample size of 36 patients (19 males and 17 females) with an age ranged between 30 days and 12 years (mean age 25.5 months). All cases were diagnosed to have complex CHD clinically and by TTE then referred to undergo cardiac low kVp ECG-gated MDCTA to confirm diagnosis and for better assessment of extra-cardiac major vessels abnormalities. Data derived from both modalities were then compared to calculate the inter-technique variability by using Cohen’s kappa statistics. Results TTE diagnosed 96% of intra-cardiac anomalies and only 54% of extra-cardiac major vessels anomalies detected by MDCTA, with variable degrees of intermodality agreement in detection different anomalies ranging between perfect agreement in diagnosing most of intra-cardiac lesions and very poor agreement in diagnosing extra-cardiac SVC anomalies. Conclusion Low kVp ECG-gated cardiac MDCTA is a rapid, non-invasive and reliable diagnostic modality in complex congenital heart diseases. It confirms TTE findings in intra-cardiac anomalies and significantly surpasses TTE reliability in diagnosis of extra-cardiac major vessels anomalies. So, it is indispensable as part of adequate preoperative assessment algorithm in cases of complex CHD and can't be replaced by TTE even with the later providing accurate assessment of intra-cardiac anomalies.

The Potential Benefit of Multi- Detector Computed Tomography for The Diagnosis of Pediatric Congenital Heart Diseases

“…Our study showed moderate agreement between MDCT and Echocardiography in diagnosis of left sided SVC (Kappa =0.435, P =0.004, with AUC of 0.976). This was close to Abdullah et al (17) and Ali et al (10) who showed that MDCT was superior to TTE in diagnosing SVC anomalies.…”

“…908, P <0.001) with area under the curve was 0.898. Ali et al (1) and Ali et al (10) agreed with the current study, and they stated that there was very good agreement between MDCT and Echo in detecting ASD, VSD, and combined ASD and VSD where k 0.851. However, Saad et al (11) demonstrated that Echo was more effective than MDCT at detecting ASD, ASD, and septal aneurysms.…”

“…This agreed with Ali et al (1) and Goitein et al (19) who reported that MDCT yielded additional diagnostic information in case of MAPCAs by 92%. Good agreement between the two modalities was demonstrated by Ali et al (10) in favor of MDCTA, where the latter found 10 instances while TTE detected only 7 cases (kappa value of 0.7).…”

“…, Ali et al (10) and Ou et al (18) who stated that the recommended imaging method for aortic abnormalities was MDCTA.…”

The Application of Retrospective ECG Gated 320-MSCT Angiography in Diagnosis of Congenital Pulmonary Arterial Anomalies in Pediatrics

“…Regarding the pulmonary artery branches (RPA and LPA), Chi square test revealed a statistically significant difference between both ECHO and MSCT in their assessment (p=0.008). This came in agreement with Liu et al, (2016) [21] and Ali et al, (2020) [22] who declared that MDCT was much informative than ECHO which missed the diagnosis of pulmonary artery anomalies and other extracardiac vascular anomalies due to limited acoustic windows, low spatial resolution and structures are obscured by overlying bone and aerated lung.…”