Multi-Detektor-CT zur Diagnostik angeborener Gefäßanomalien und ihrer Begleitbefunde bei Neugeborenen und Kleinkindern

Purpose: To assess the value of multidetector CT (MDCT) for evaluation of vascular anomalies (VA) and associated complications in newborns and infants. Materials and Methods: Seventy-five children (mean age: 9 +/- 6 months, range: 2 weeks to 24 months) with VA were examined using MDCT (4-, 8- or 16-row; collimation 0.5 - 1.25 mm; scan time 7 - 30s), which was performed under controlled ventilation or free breathing. Image quality was rated using a 5-point scale. Image findings were correlated to echocardiography, conventional catheter angiography (CCA), bronchoscopy, and intraoperative findings. Results: High quality MDCT data were almost free of cardiac and respiratory motion. In all cases, VA morphology and topography in relation to adjacent structures, e. g. tracheal and esophageal compression caused by an aortic ring, could be assessed exactly and allowed the final diagnosis. Even aberrant vessels, such as aorto-pulmonary collaterals (MAPCA) with a diameter of less than 1 mm, could be identified and excellently visualized. Eighty percent (60/75) of all patients had benefited from the MDCT: in 31 patients CCA was neither necessary to perform surgical planning nor to exclude a VA; in an additional 29 patients radiation doses and sedation time due to interventional procedures could be reduced markedly. Conclusions: MDCT can now be regarded as the modality of choice as a minimally invasive, robust, and accurate technique for the diagnosis of complex VA, their potentially life-threatening complications and preoperative planning even in newborns and infants. Its accuracy for detecting VA appears equivalent to CCA while it is more accurate in delineating potential life-threatening complications.