Low dose dual-source CT angiography in infants with complex congenital heart disease: A randomized study

Objectives: To investigate the radiation dose and image quality of prospective ECG-triggering dual-source CT angiography in infants with complex congenital heart disease (CHD) in comparison with retrospective ECG-gated scanning. Methods: Ninety-six infants less than 1 year old (60/36 male/female, age: 4.8 ± 2.7 months, weight: 5.8 ± 1.8 kg) with complex CHD were enrolled. Three image acquisition protocols were set: group 1: 80 kV, 100 mA, retrospective ECG-gated protocol; group 2: 80 kV, 100 mA, prospective ECG-triggering protocol with acquisition window of 380 ms; group 3: 80 kV, 100 mA, prospective ECG-triggering protocol with acquisition window of 200 ms. Patients were selected to any one of the protocols randomly. The signal-to-noise ratios (SNR) were calculated in the ascending aorta and the pulmonary artery trunk. Image quality was assessed by a five-point score. A score of <3 represents non-diagnostic. Effective radiation dose (ED) was calculated. Results: Image quality score of groups 1, 2 and 3 were 4.1 ± 0.4, 4.0 ± 0.6 and 4.2 ± 0.6 (p = 0.224). SNR of ascending aorta and pulmonary artery trunk among them had no statistical difference (all p > 0.05). The average ED (median) of groups 1, 2 and 3 were 1.17 ± 0.07 mSv (1.25 mSv), 0.72 ± 0.24 mSv (0.78 mSv) and 0.48 ± 0.41 mSv (0.39 mSv). Any two of the three groups had significant differences (all p < 0.001). Conclusion: Prospective ECG-triggering DSCT angiography associated with a significantly lower ED than retrospective protocol, while maintaining image quality for diagnosis. Prospective ECG-triggering DSCT angiography could be used as a very important second-line diagnostic tool in infants with complex CHD.