Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT working group of the Italian Society of Pediatric Cardiology (SICP) and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) Part I

Abstract

Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. Nevertheless, correct execution and interpretation require in-depth knowledge of all technical and clinical aspects of CHD, a careful assessment of risks and benefits before each exam, proper imaging protocols to maximize diagnostic information, minimizing harm. This position paper, written by experts from the Working Group of the Italian Society of Pediatric Cardiology and from the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, is intended as a practical guide for applying CCT and CMR in children and adults with CHD, wishing to support Radiologists, Pediatricians, Cardiologists and Cardiac Surgeons in the multimodality diagnostic approach to these patients. The first part provides a review of the most relevant literature in the field, describes each modality's advantage and drawback, making considerations on the main applications, image quality, and safety issues. The second part focuses on clinical indications and appropriateness criteria for CMR and CCT, considering the level of CHD complexity, the clinical and logistic setting and the operator expertise.

Outcomes of bidirectional Glenn surgery done without prior cardiac catheterization

“…Brown et al did not find significant differences in short-term or long-term outcomes between patients with univentricular hearts who underwent routine pre-BDG catheterization and those who underwent only cardiac MRI [12]. We think that with time, the noninvasive imaging modalities will gradually replace diagnostic cardiac catheterization, especially with the rapid progress in artificial intelligence involved in the novel imaging tools [15]. Until then, the debate and argument will continue between who supports catheterization before every BDG surgery and who does not.…”

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

“…When available, CMR is usually considered the more appropriate choice for further assessment, since it avoids iodate contrast and radiation. It is usually reasonable to perform CMR every 3–5 years, starting from the age of 8, unless an urgent assessment is necessary [ 35 ], and a baseline assessment is recommended at the time of transition from paediatric to ACHD programmes [ 75 ]. This technique can accurately quantify the volume and EF of the dominant ventricle and AV valve regurgitation; it gives accurate information about the patency of the pathways and the aortic arch, and it images collaterals and provides tissue characterisation and feasible 3D reconstructions [ 74 , 75 ].…”

“…It is usually reasonable to perform CMR every 3–5 years, starting from the age of 8, unless an urgent assessment is necessary [ 35 ], and a baseline assessment is recommended at the time of transition from paediatric to ACHD programmes [ 75 ]. This technique can accurately quantify the volume and EF of the dominant ventricle and AV valve regurgitation; it gives accurate information about the patency of the pathways and the aortic arch, and it images collaterals and provides tissue characterisation and feasible 3D reconstructions [ 74 , 75 ]. The long scan time, the need for general anaesthesia for non-cooperative patients, and artefacts due to implanted devices are still the main limitations of this technique, but the development of faster sequences and 3D and 4D flow analyses have the potential to overcome these limitations in the near future [ 37 , 40 ].…”

“…Lastly, CCT is a valid alternative to CMR thanks to its high spatial and temporal resolution and rapid acquisition time, making this imaging modality ideal for acute situations and a powerful tool for the comprehensive anatomical evaluation of cardiac and extracardiac vascular structures and of vascular stents and to guide surgical or percutaneous interventions [ 38 , 75 ]. Other than in an acute setting, it is reasonable to perform it with a frequency similar to CMR, but well-defined recommendations are not available at the moment.…”

Gender Medicine in Clinical Radiology Practice

“…CMR is a high-spatial- and -temporal-resolution, noninvasive imaging modality that offers the added benefit of no exposure to ionizing radiation, so it is particularly advantageous in women of childbearing age. CMR also provides excellent assessment of myocardial structure and function, as well as signs of inflammation, ischemia, and myocardial viability [ 44 , 45 , 46 , 47 , 48 ].…”