Contrast blending for right ventricular function in pediatric patients
Judy Oltman, USA, has sent the following question:
We do a fair amount of pediatric congenital hearts and need to assess right ventricular function. Are there any particular blends of contrast administration that works well with attemping to get appropriate contrast fill without too much contamination?
Kai U. Juergens, M.D., Section Head of Body CT and PET/CT, Department of Clinical Radiology, University of Muenster:
Dear Mrs. Oltmann,
thank you for your question regarding particular blends of contrast administration in pediatric patients. At our institution, we prefer MRI evaluating congenital heart diseases in pediatric patients due to unnecessary radiation exposure, excellent temporal resolution provided by MRI (mandatory for right ventricular (RV) function analysis), and the ability to achieve quantitative functional information with regard to valves, shunts etc.
Although I do agree, that DSCT might be clinically indicated, e.g. in patients with congenital heart disease and possible concomitant coronary anomalies.
DSCT enables scanning at very high heart rates (>> 100 bpm) and, even, in these young patients, achieves images in diastolic and systolic phases with excellent spatial resolution. The DSCT protocol should be individually tailored adjusting the kV and mAs as well as the amount of contrast agent applied to the respective body constitution, body weight, and age of the pediatric patient. Based on our experience with adult patients, a second bolus of contrast agent diluted with saline, e.g. 30/70%, that is injected after the main bolus, might achieve homogenous opafication of the RV lumen and delineation of RV myocardium and septum.
Best regards,
Kai U. Juergens
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Thank you for your response. I may have failed to mention, the pediatrics that we scan have congenital anomalies and many have had step surgical interventions. The mapping of the anatomy is critical for the surgeon. In the interum, we have adapted a total 80/20 blend of contrast, using a lesser kVp is possible because of that. Injecting in a saphenous vein decreased the SVC contrast artifact possibility, so again allows a decrease radiation dose. Many of our peds have a HR in the 130-150 bpm range. A 3-4 second scan at most. Aain, I appreciate your response to my question.