Investigation of an appropriate contrast-enhanced CT protocol for young patients following the Fontan operation

  • Motoo Nakagawa
  • Yoshiyuki Ozawa
  • Norikazu Nomura
  • Sachiko Inukai
  • Ayano Shiba
  • Keita Sakurai
  • Masashi Shimohira
  • Yuta Shibamoto
Original Article
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Abstract

Purpose

Children with congenital heart diseases (CHDs) may need to be followed up with contrast-enhanced CT following the Fontan operation because complications such as the occlusion of conduits may occur. The purpose of the present study was to develop an adequate contrast-enhanced CT protocol for children with CHD following the Fontan operation.

Materials and methods

Between July 2012 and July 2017, 29 CT examinations for 26 patients aged 2–11 years (median 5 years) with CHD following the Fontan operation were performed using dual-source CT. A non-ionized contrast medium was injected through the dorsum manus vein. Scanning began 60 or 70 s after the start of the injection. The delayed phase was randomly selected to be 60 s in 14 cases and 70 s in 15 cases. We evaluated the enhancement of conduits following the Fontan operation at delayed phases.

Results

The CT numbers of conduits at 60 and 70 s were 185 ± 46 and 185 ± 31 HU, respectively (P = 0.97).

Conclusion

In contrast-enhanced CT for children after the Fontan operation, both of the delayed phases (60 and 70 s) appeared to be adequate for evaluating intraconduit patency.

Keywords

Congenital heart disease Computed tomography Fontan operation 

Notes

Acknowledgements

This work was supported by JSPS KAKENHI Grant number 16K19838.

Compliance with ethical standards

Conflict of interest

The other authors declare that they have no conflicts of interest.

References

  1. 1.
    Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971;26:240–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Khanna G, Bhalla S, Krishnamurthy R, Canter C. Extracardiac complications of the Fontan circuit. Pediatr Radiol. 2012;42:233–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Nakagawa M, Ozawa Y, Nomura N, Inukai S, Tsubokura S, Sakurai K, et al. Utility of dual source CT with ECG-triggered high-pitch spiral acquisition (Flash Spiral Cardio mode) to evaluate morphological features of ventricles in children with complex congenital heart defects. Jpn J Radiol. 2016;34:284–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Nakagawa M, Hara M, Oshima H, Shibamoto Y, Mizuno K, Asano M. Comparison of 16-multidetector-row computed tomography and angiocardiography for evaluating the central pulmonary artery diameter and pulmonary artery index in children with congenital heart disease. Radiat Med. 2008;26:337–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Nakagawa M, Ozawa Y, Sakurai K, Shimohira M, Ohashi K, Asano M, et al. Image quality at low tube voltage (70 kV) and sinogram-affirmed iterative reconstruction for computed tomography in infants with congenital heart disease. Pediatr Radiol. 2015;45:1472–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Shirota G, Maeda E, Namiki Y, Bari R, Ino K, Torigoe R, et al. Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction. Pediatr Radiol. 2017;47:1463–70.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Liu Y, Li J, Zhao H, Jia Y, Ren J, Xu J, et al. Image quality and radiation dose of dual-source CT cardiac angiography using prospective ECG-triggering technique in pediatric patients with congenital heart disease. J Cardiothorac Surg. 2016;11:47.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rompel O, Glöckler M, Janka R, Dittrich S, Cesnjevar R, Lell MM, et al. Third-generation dual-source 70-kVp chest CT angiography with advanced iterative reconstruction in young children: image quality and radiation dose reduction. Pediatr Radiol. 2016;46:462–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Greenberg SB, Bhutta ST. A dual contrast injection technique for multidetector computed tomography angiography of Fontan procedures. Int J Cardiovasc Imaging. 2008;24:345–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Wallihan DB, Podberesky DJ. Hepatic pathology after Fontan palliation: spectrum of imaging findings. Pediatr Radiol. 2013;43:330–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Park EA, Lee W, Chung SY, Yin YH, Chung JW, Park JH. Optimal scan timing and intravenous route for contrast-enhanced computed tomography in patients after Fontan operation. J Comput Assist Tomogr. 2010;34:75–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Nakagawa M, Hara M, Shibamoto Y. A prospective study to evaluate the depictability of the hepatic veins on abdominal contrast-enhanced CT in small children. Pediatr Radiol. 2009;39:933–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Heinemann M, Breuer J, Steger V, Steil E, Sieverding L, Ziemer G. Incidence and impact of systemic venous collateral development after Glenn and Fontan procedures. Thorac Cardiovasc Surg. 2001;49:172–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Deak PD, Smal Y, Kalender WA. Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology. 2010;257:158–66.CrossRefPubMedGoogle Scholar
  15. 15.
    Boone J, Strauss K, Cody D, McCollough CH, McNitt-Gray MF, Toth TL. Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. In: Report of AAPM Task Group 204. College Park: American Association of Physicists in Medicine; 2011.Google Scholar
  16. 16.
    Marsden AL, Bernstein AJ, Reddy VM, Shadden SC, Spilker RL, Chan FP, et al. Evaluation of a novel Y-shaped extracardiac Fontan baffle using computational fluid dynamics. J Thorac Cardiovasc Surg. 2009;137:394–403.CrossRefPubMedGoogle Scholar
  17. 17.
    Sundareswaran KS, Haggerty CM, de Zélicourt D, Dasi LP, Pekkan K, Frakes DH, et al. Visualization of flow structures in Fontan patients using 3-dimensional phase contrast magnetic resonance imaging. J Thorac Cardiovasc Surg. 2012;143:1108–16.CrossRefPubMedGoogle Scholar
  18. 18.
    Prabhu SP, Mahmood S, Sena L, Lee EY. MDCT evaluation of pulmonary embolism in children and young adults following a lateral tunnel Fontan procedure: optimizing contrast-enhancement techniques. Pediatr Radiol. 2009;39:938–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Hakim W, Kamanahalli R, Dick E, Bharwani N, Fetherston S, Kashef E. Trauma whole-body MDCT: an assessment of image quality in conventional dual-phase and modified biphasic injection. Br J Radiol. 2016;89:20160160.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sugiyama H, Yoo SJ, Williams W, Benson LN. Characterization and treatment of systemic venous to pulmonary venous collaterals seen after the Fontan operation. Cardiol Young. 2003;13:424–30.PubMedGoogle Scholar
  21. 21.
    Poterucha JT, Johnson JN, Taggart NW, Cabalka AK, Hagler DJ, Driscoll DJ, et al. Embolization of veno-venous collaterals after the Fontan operation is associated with decreased survival. Congenit Heart Dis. 2015;10:E230–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japan Radiological Society 2018

Authors and Affiliations

  • Motoo Nakagawa
    • 1
  • Yoshiyuki Ozawa
    • 2
  • Norikazu Nomura
    • 3
  • Sachiko Inukai
    • 4
  • Ayano Shiba
    • 2
  • Keita Sakurai
    • 2
  • Masashi Shimohira
    • 2
  • Yuta Shibamoto
    • 2
  1. 1.Department of RadiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of RadiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
  3. 3.Department of Cardiovascular SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
  4. 4.Department of Pediatrics and NeonatologyNagoya City University Graduate School of Medical SciencesNagoyaJapan

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