Rajesh Krishnamurthy MD, Presenter: Research Consultant, Eisai Co, Ltd Research support, Koninklijke Philips Electronics NV Scientific Advisory Board, Vital Images, Inc

Benjamin J. Toole, Abstract Co-Author: Nothing to Disclose

Dean E. McKenzie, Abstract Co-Author: Nothing to Disclose

Matthew A. Crystal MD, Abstract Co-Author: Nothing to Disclose

Cardiac catheterization (cath) is considered the gold standard for delineation of anatomy in children with pulmonary atresia / ventricular septal defect / major aortopulmonary collaterals (PA/VSD/MAPCAs). The objective of this study was to test the hypothesis that CTA is equivalent to cath for preoperative anatomic delineation in these patients.

9 children with PA/VSD/MAPCAs had a cath and CTA in close proximity to each other without interval therapy. A retrospective review of these 9 patients was performed. 5 CTAs were performed with a 320 detector CT using a volume technique, and 4 with a 64-detector CT with a helical technique. Blinded review of caths was performed by a an interventional cardiologist and CTAs by a pediatric radiologist. Pulmonary artery morphology, MAPCAs and type of blood supply (dual versus single supply) to 20 study-defined pulmonary artery (PA) segments were evaluated. Means were compared using unpaired t-test, and Mann-Whitney rank sum was used when data was not normally distributed.

PA anatomy (confluent vs. non-confluent) was correctly identified in 9/9 patients by CTA and in 8/9 patients by cath as confirmed at time of surgery. In the one patient that differed, native PAs were not seen by cath, but were identified by CTA. An equal number of MAPCAs were identified by both cath and CTA in 6/9 patients. CTA was equivalent to cath in identification of MAPCAs (mean= 3.4 collaterals/study via cath; mean=3.1 collaterals/study via CTA; p = 0.67). In 8/9 CTAs, the blood supply to all 20 study-defined pulmonary segments was identified (mean=19.5 pulmonary segments); however, the blood supply to all 20 pulmonary segments was identified in only 1/9 patients via cath (mean=17.5 segments). CTA was able to better delineate segmental pulmonary blood flow than cath (p = 0.006).  

CTA and catheterization are equivalent in their ability to delineate pulmonary artery anatomy and MAPCAs. CTA was able to more clearly delineate pulmonary segmental blood supply due to the 3D nature of CT as compared with the 2D images of catheterization which cause superimposition on the lateral projection. 

In the setting of PA/VSD/MAPCAS, CTA and cath are equivalent in their ability to delineate pulmonary artery anatomy and MAPCAs. CTA is superior to cath for evaluation of segmental pulmonary blood flow

Krishnamurthy, R, Toole, B, McKenzie, D, Crystal, M, Comparison of CT Angiography and Cardiac Catheterization for Evaluating Major Aorto-pulmonary Collateral Arteries in Children with Pulmonary Atresia and Ventricular Septal Defect.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028963.html