The diagnostic value of dynamic volume computed tomography angiography in children with anomalous origin of the left coronary artery from the pulmonary artery

There have been almost no reports on the technique of dynamic volume computed tomography angiography (DVCTA) in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Twelve children with ALCAPA, aged 5 months to 15 years, were enrolled in this retrospective study to explore the clinical value of DVCTA in the diagnosis of ALCAPA in children. All patients underwent low-dose prospective ECG-gated 320-slice DVCTA and transthoracic echocardiography. Two radiologists evaluated the image quality of the DVCTA and recorded the radiation dose at the same time. The accuracy of DVCTA in the diagnosis of ALCAPA was 100%, with the left coronary artery (LCA) opening in the left wall of the pulmonary artery in 4 cases (33.3%), the right wall in 2 cases (16.7%), and the posterior wall in 6 cases (50.0%). All children completed 320-slice DVCTA at a single timepoint; all of the images were diagnosable, and the subjective score was 3.3 +/- 0.6, with good consistency between the evaluations performed by the two radiologists (k=0.79). From the echocardiographs of these cases, 4 cases (33.3%) of ALCAPA were diagnosed correctly, 4 cases (33.3%) were misdiagnosed as LCA-pulmonary artery fistula, and 4 cases (33.3%) were missed, including a small LCA that was not displayed in 2 cases. The average CT radiation dose was 0.83 +/- 0.57 mSv. Low-dose DVCTA clearly showed the origin, course, and collateral vessels of ALCAPA and could be used reliably for noninvasive diagnosis of ALCAPA in children.