Clinical application of dual-source CT in diagnosis of coronary artery fistulas in children

Objective: To explore the clinical application of low-dose dual-source CT (DSCT) angiography in diagnosis of coronary artery fistulas (CAF) in children. Methods: A total of 22 patients [mean age (3.2 ± 1.5) yrs,age range 1.2-6.0 yrs; male 12, female 10] with CAF who underwent DSCT angiography under free breathing were retrospectively reviewed. Surgery was performed in 9 patients,and transcatheter closure in 13 patients. The diagnostic accuracy of DSCT was evaluated based on the surgical or conventional cardiac angiography (CCA) findings. The subjective image quality was evaluated on a four-point scale by two radiologists. Radiation dose values were recorded. Interobserver agreement of subjective image quality grading was assessed by using Kappa statistics. Results: All images were diagnosable. The average subjective image quality score was 2.6 ± 0.7. Two radiologists made good agreement (K = 0.75, P<0.05). Twenty-five coronary artery fistulas in all patients were clearly displayed on DSCT images with accuracy of 100%. CAF arose from right coronary artery in 13 (59.1%) cases, from left coronary artery in 8 (36.4%) cases and from dual coronary arteries in 1 (4.5%) case. There were 4 patients associated with coronary artery aneurysms. The mean dose-length product (DLP) was (25 ± 4) mGy · cm resulting in an estimated mean effective radiation dose of (0.25 ± 0.07) mSv. Conclusion: Low-dose DSCT angiography provides accurate and reliable diagnosis for coronary artery fistulas in children. (authors)