الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Congenital thoracic vascular anomalies comprise a wide spectrum of anomalies involving the thoracic aorta and its branches, the coronary arteries, the pulmonary arteries, the pulmonary veins and the thoracic systemic veins. Echocardiography is the first-line imaging modality. For definitive preoperative diagnosis, invasive cardiac catheterization has long been the modality of choice. Multi-detector computed tomography technology is increasingly used as a non-invasive alternative due to advantages of high spatial and temporal resolution, three-dimensional reconstruction and rapid acquisition. Although radiation exposure is the main drawback of CT, low-dose protocols are now available.
The aim of this study was to evaluate the role of 64-slice multidetector computed tomography in the diagnosis of abnormal systemic and pulmonary vascular connections and the associated congenital anomalies in comparison to echocardiography.
The study enrolled one hundred consecutive patients with the provisional diagnosis of congenital heart disease referred for further evaluation by MDCT. Low dose protocol was used for imaging. ECG-gating was used only when coronary anatomy needed to be defined. The mean effective radiation dose was 1.4±0.8mSv for non-gated acquisition and 5.4±2.3mSv in retrospective-gated scans.
The study included 60 males and 40 females. The age ranged from 15 days to 20 years with a mean age of 3.5±5.2 years, with 6 neonates (<1month), 55 infants (<1year) and 7 adults (above 16 years). Acyanotic CHD constituted 57% of the study population and cyanotic heart disease constituted 43%. In the 100 consecutive cases, there were 91 abnormal vascular connections in 73 cases, 32 abnormal venous connections and 59 abnormal arterial connections.
Anomalous pulmonary veins were present in 19 cases, 11 cases of PAPVC and 8 cases of TAPVC. In PAPVC, 9 cases were PAPVC with ASD, most of which were sinus venosus type, a case of PAPVC with intact interatrial septum and a case of PAPVC with complex CHD. The majority were right-sided anomalous veins. In TAPVC, 5 were supracardiac, one cardiac, one infracardiac and one mixed. Half of the cases were isolated TAPVC.
There was significant agreement between echocardiography and MDCT in the diagnosis of PAPVC but not in determining the site drainage or the number of anomalous veins, in which MDCT was more accurate. In comparison to MDCT, echocardiography had a sensitivity of 90.9% and a specificity of 95.5% in the diagnosis of PAPVC, while only a sensitivity of 45.5% in determining the site of drainage and 54.5% in determining the number of anomalous veins. Similarly, there was significant agreement between echocardiography and MDCT in the diagnosis of TAPVC but not in determining the site of drainage, in which MDCT was more accurate. In comparison to MDCT, echocardiography had a sensitivity of 100% and a specificity of 98.9% in the diagnosis of TAPVC, and a sensitivity of 75% in determining the site of drainage. Echocardiography showed the intracardiac defects in all cases, including that missed by MDCT.