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Pediatric Imaging

E1194. Comparison of CTA, TTE, and TEE for Detection and Characterization of Coronary Anomalies in Infants

Sridhar S1,  Richardson R.2 1. Department of Radiology, University of New Mexico, Albuquerque, United States; 2. Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, United States

Address correspondence to S. Sridhar (shravs@email.arizona.edu)

Objective: Compared with transthoracic (TTE) and transesophageal (TEE) echocardiography, CT angiography (CTA) offers higher spatial resolution, operator independence, 3D-reconstruction, and is noninvasive, , enabling better detection of coronary artery anomalies. The ability of CTA to describe coronary artery anomalies, often incidentally found, has been studied in the adult population. However, the ability of CTA to accurately detect coronary artery anomalies in the population of infants with comorbid congenital cardiac malformations has not been well studied. Furthermore, there is no information about the ability of CTA to properly characterize the anatomy at the origin, course, and termination of coronary arteries, whether normal or anomalous. In this study, we report the sensitivity and specificity of CTA, TTE, and TEE for detection of coronary anomalies and compare the relative efficacy of each modality in anatomic characterization at coronary artery origin, course, and termination.

Materials and Methods: Imaging and surgical data for 27 patients aged 2.2 ± 0.7 months presenting for initial evaluation of congenital heart disease between 2006 and 2011 were evaluated. Patients had undergone EKG-gated 64-slice cardiac CTA with 3D reconstruction in addition to multiple TTE and TEE studies. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each modality in the detection of coronary artery anomalies were computed. Concordance between each modality and the reference standard (surgery or conventional angiography) in characterization of anatomy along the origin, course, and termination of anomalous coronary arteries was evaluated.

Results: CTA demonstrated highest sensitivity (80%) and accuracy (74%) while TEE demonstrated the highest specificity (100%) for coronary artery anomaly detection. CTA outperformed TTE and TEE at characterizing anatomy at the origin and course of an anomalous coronary artery. CTA outperformed TEE but did not significantly outperform TTE at characterizing anatomy at the termination of an anomalous coronary artery.

Conclusion: CTA is the most sensitive and accurate modality for detection of coronary artery anomalies in infants and is optimal for characterizing anatomy along the entire length of an anomalous coronary artery. As such, CTA may be appropriate for first-line coronary artery imaging in infants with a high pretest probability for having a coronary artery anomaly.