Safety and accuracy of dual-source coronary computed tomography angiography in the pediatric population

BACKGROUND: High heart rates and radiation sensitivity have limited the use of coronary computed tomography angiography (CTA) in pediatric patients. OBJECTIVE: A contemporary evaluation of image quality and reduction in radiation exposure with dual-source CT technology has not been reported in a large cohort of pediatric patients undergoing coronary angiography. METHODS: Consecutive coronary CTA scans (n = 71) in 70 pediatric patients were retrospectively reviewed. Metoprolol was administered for heart rate control. Scans were divided by acquisition mode into 3 groups: retrospective electrocardiogram (ECG)-triggered spiral, prospective ECG-triggered, and prospective ECG-triggered high-pitch spiral scans. Heart rate, radiation dose, image quality, and diagnostic confidence were compared between groups. RESULTS: Median decrease in heart rate with metoprolol was 24% +/- 14%. Median effective age-adjusted radiation dose for the entire group was 0.97 +/- 1.20 mSv. Retrospective ECG-triggered scans had a median dose of 1.71 +/- 1.4 mSv, prospectively ECG-triggered scans had a median dose of 0.9 +/- 1.1 mSv, and prospectively ECG-triggered high-pitch spiral scans had a median effective dose of 0.27 +/- 0.4 mSv. The difference between groups was statistically significant (P < 0.05). The contrast-to-noise ratio and the image quality score were similar between groups. CONCLUSION: Dual-source coronary CTA with a beta-blocker protocol uniformly achieves diagnostic coronary scans at a low radiation dose in pediatric patients. Image quality and diagnostic confidence are excellent for all scan modes in a wide spectrum of patients. (C) 2012 Society of Cardiovascular Computed Tomography. All rights reserved.