Contrast blending for right heart and ventricular function in pediatric patiens
Judy Oltman, USA, has sent the following question:
Contrast blending for right ventricular function:
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?
Thorsten R.C. Johnson, M.D., University Hospital Munich-Grosshadern:
Optimizing contrast injection for the evaluation of right heart and ventricular function in children is very challenging indeed. Generally, one can use a blend of 30% contrast with 70% saline as chaser bolus instead of pure saline to obtain a right ventricular opacification without severe streak artifacts. Some injectors (e.g. Medrad Stellant) provide the option to use both injector heads simultaneously by defining multi-phase protocols.
The obtainable flow rates and volumes depend on the size of the child and the iv access, so that it is hardly possible to make general recommendations for volumes and flow rates in children. Normal-concentration media (i.e. 300 mg/ml) are better for small bore access. In babies, it is frequently necessary to just inject by hand at maximum achievable flow rate and scan after a few seconds. In toddlers who can hold their breath, it is sometimes feasible to do a test bolus to optimize scan delay (aortic peak) and bolus size (flow multiplied by delay of pulmonary peak).
Generally, MRI or 3D echocardiography are better modalities for the evaluation of right ventricular morphology and function. For cardiac MRI of children, general anesthesia and a patient anesthesiologist are required, but the combination of dynamic short and long axis acquisitions, multi-phase thoracic angiography and flow mesasurements over the valves can provide a full funtional and morphological workup without radiation, so one should always consider MRI before scanning childeren with congenital heart disease in CT.
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To Johnson
Hello!
My name is Mi-Jin, Kang, Seoul National University Hospital, Korea.
Actually I presented educational exhibit of ‘thoracic application of dual energy CT’, at RSNA 2009.
And My presentation was received invitation of Radiographics.
If you don’t mind, I would like to use your figure 2 and 3, printed at Eur Radiol 2007;17:1510-1517.
I will wait for your answer, sincerely.
Thank you.
Thanks for your interest. Of course I had to transfer the copyright of the article including its images to the publisher, i.e. Springer. According to their guidelines I think you have to give reference to the original article in the figure caption. Please refer to the Springer website to make sure you’re meeting their copyright requirements.