Technical Principles of Computed Tomographic Angiography for Adult Congenital Heart Disease

  • Wojciech Mazur
  • Marilyn J. Siegel
  • Tomasz Miszalski-Jamka
  • Robert Pelberg


The computed tomographic angiography (CTA) imaging protocol must be tailored to the suspected cardiac lesion and the type of prior surgical repair. The relevant parameters that need to be selected prior to imaging are contrast volume, contrast injection speed, the timing of the scan, slice collimation, scan length, tube voltage (kV), tube current (mA), and pitch. In addition, the imager must decide on the use of non-ECG-synchronized acquisition versus ECG synchronization (prospective or retrospective). In general, multidetector scanner with ≥64 rows is preferred for evaluation of congenital heart disease (CHD).


Congenital Heart Disease Compute Tomographic Angiography Iterative Reconstruction Filter Back Projection Cardiac Compute Tomographic Angiography 
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  1. 1.
    Yalonetsky S, Horlick EM, Osten MD, Benson LN, Oechslin EN, Silversides CK. Clinical characteristics of coronary artery disease in adults with congenital heart defects. Int J Cardiol. 2011. doi: 10.1016/j.ijcard.2011.07.021.Google Scholar
  2. 2.
    Stulak JM, Dearani JA, Burkhart HM, Ammash NM, Phillips SD, Schaff HV. Coronary artery disease in adult congenital heart disease: outcome after coronary artery bypass grafting. Ann Thorac Surg. 2012;93:116–22. doi: 10.1016/j.athoracsur.2011.09.013; discussion 122–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA. 2009;301:500–7. doi: 10.1001/jama.2009.54.PubMedCrossRefGoogle Scholar
  4. 4.
    Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S, et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation. 2006;113:1305–10. doi: 10.1161/CIRCULATIONAHA.105.602490.PubMedCrossRefGoogle Scholar
  5. 5.
    Leschka S, Scheffel H, Desbiolles L, Plass A, Gaemperli O, Valenta I, et al. Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol. 2007;42:543–9. doi: 10.1097/RLI.0b013e31803b93cf.PubMedCrossRefGoogle Scholar
  6. 6.
    Weustink AC, Mollet NR, Pugliese F, Meijboom WB, Nieman K, Heijenbrok-Kal MH, et al. Optimal electrocardiographic pulsing windows and heart rate: effect on image quality and radiation exposure at dual-source coronary CT angiography. Radiology. 2008;248:792–8. doi: 10.1148/radiol.2483072098.PubMedCrossRefGoogle Scholar
  7. 7.
    Bischoff B, Hein F, Meyer T, Hadamitzky M, Martinoff S, Schomig A, et al. Impact of a reduced tube voltage on CT angiography and radiation dose: results of the PROTECTION I study. JACC Cardiovasc Imaging. 2009;2:940–6. doi: 10.1016/j.jcmg.2009.02.015.PubMedCrossRefGoogle Scholar
  8. 8.
    Suess C, Chen X. Dose optimization in pediatric CT: current technology and future innovations. Pediatr Radiol. 2002;32:729–34. doi: 10.1007/s00247-002-0800-x; discussion 751–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Achenbach S, Goroll T, Seltmann M, Pflederer T, Anders K, Ropers D, et al. Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. JACC Cardiovasc Imaging. 2011;4:328–37.PubMedCrossRefGoogle Scholar
  10. 10.
    Goetti R, Baumuller S, Feuchtner G, Stolzmann P, Karlo C, Alkadhi H, et al. High-pitch dual-source CT angiography of the thoracic and abdominal aorta: is simultaneous coronary artery assessment possible? AJR Am J Roentgenol. 2010;194:938–44. doi: 10.2214/AJR.09.3482.PubMedCrossRefGoogle Scholar
  11. 11.
    Goo HW, Yang DH. Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan. Pediatr Radiol. 2010;40:1670–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Halliburton SS, Abbara S, Chen MY, Gentry R, Mahesh M, Raff GL, et al. Society of Cardiovascular Computed Tomography. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 2011;5:198–224. doi: 10.1016/j.jcct.2011.06.001.PubMedCrossRefGoogle Scholar
  13. 13.
    Maruyama T, Takada M, Hasuike T, Yoshikawa A, Namimatsu E, Yoshizumi T. Radiation dose reduction and coronary assessability of prospective electrocardiogram-gated computed tomography coronary angiography: comparison with retrospective electrocardiogram-gated helical scan. J Am Coll Cardiol. 2008;52:1450–5. doi: 10.1016/j.jacc.2008.07.048.PubMedCrossRefGoogle Scholar
  14. 14.
    Labounty TM, Leipsic J, Min JK, Heilbron B, Mancini GB, Lin FY, et al. Effect of padding duration on radiation dose and image interpretation in prospectively ECG-triggered coronary CT angiography. AJR Am J Roentgenol. 2010;194:933–7. doi: 10.2214/AJR.09.3371.PubMedCrossRefGoogle Scholar
  15. 15.
    Leipsic J, Labounty TM, Heilbron B, Min JK, Mancini GB, Lin FY, et al. Estimated radiation dose reduction using adaptive statistical iterative reconstruction in coronary CT angiography: the ERASIR study. AJR Am J Roentgenol. 2010;195:655–60. doi: 10.2214/AJR.10.4288.PubMedCrossRefGoogle Scholar
  16. 16.
    Renker M, Ramachandra A, Schoepf UJ, Raupach R, Apfaltrer P, Rowe GW, et al. Iterative image reconstruction techniques: applications for cardiac CT. J Cardiovasc Comput Tomogr. 2011;5:225–30. doi: 10.1016/j.jcct.2011.05.002.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Wojciech Mazur
    • 1
  • Marilyn J. Siegel
    • 2
  • Tomasz Miszalski-Jamka
    • 3
    • 4
  • Robert Pelberg
    • 1
  1. 1.The Christ Hospital Heart and Vascular Center of Greater CincinnatiThe Lindner Center for Research and EducationCincinnatiUSA
  2. 2.Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  3. 3.Department of Clinical Radiology and Imaging Diagnostics4th Military HospitalWrocławPoland
  4. 4.Center for Diagnosis Prevention and TelemedicineJohn Paul II HospitalKrakówPoland

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