Objective: This study is comparing the accuracy of MDCT with invasive contrast coronary angiography (ICA) identifying coronary abnormalities in children and adolescents.
Methods: We reviewed all patients, from Jan. 2002 to Dec. 2008, with congenital or acquired coronary abnormalities underwent either ICA, MDCT or both studies for assessment of coronary anatomy. We analyzed the coronary abnormalities and discriminations between ICA and MDCT.
Results: Thirty-three patients (20 males, 13 females) (mean age: 10.3 years) have coronary abnormalities including coronary artery aneurysm in Kawasaki disease (KD) (n=15), coronary artery fistula (n=12), myocardial bridge (n=2), anomalous left coronary artery from pulmonary artery (ALCAPA, n=4). Seventeen patients referred for ICA detected 5 coronary aneurysms (4 LCA, 1 RCA), 11 coronary artery fistulas and 2 ALCAPAs. Sixteen patients received MDCT study and 11 coronary artery aneurysms (7 LCA, 4 RCA), 2 myocardial bridges, 2 coronary artery fistulas and 2 ALCAPAs were assessed. Due to complex coronary anatomy, 5 patients with 3 large coronary aneurysms, 1 single LCA accompanied with coronary fistula, and 1 ALCAPA underwent both MDCT and ICA. Finally, 11 patients with indication of ICA spared invasive cardiac catheterization under accurate results of MDCT. Only one patient with small RCA aneurysm identified by ICA had different results of normal coronary anatomy examined by MDCT.
Conclusion: We conclude that MDCT is a good and accurate modality for assessment of congenital or acquired coronary abnormalities in children and adolescents. However, MDCT can’t replace invasive cardiac catheterization and ICA due to lack of therapeutic role.