Noninvasive imaging of congenital cardiovascular defects
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CARDIAC RADIOLOGY
Noninvasive imaging of congenital cardiovascular defects Paolo Ciancarella1 · Paolo Ciliberti2 · Teresa Pia Santangelo1 · Francesco Secchi3,4 · Nicola Stagnaro5 · Aurelio Secinaro1 Received: 9 June 2020 / Accepted: 3 September 2020 © Italian Society of Medical Radiology 2020
Abstract Advances in the treatment have drastically increased the survival rate of congenital heart disease (CHD) patients. Therefore, the prevalence of these patients is growing. Imaging plays a crucial role in the diagnosis and management of this population as a key component of patient care at all stages, especially in those patients who survived into adulthood. Over the last decades, noninvasive imaging techniques, such as cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT), progressively increased their clinical relevance, reaching stronger levels of accuracy and indications in the clinical surveillance of CHD. The current review highlights the main technical aspects and clinical applications of CMR and CCT in the setting of congenital cardiovascular abnormalities, aiming to address a state-of-the-art guidance to every physician and cardiac imager not routinely involved in the field. Keywords Cardiac magnetic resonance · Congenital heart disease · Cardiac computed tomography · Pediatric imaging
Introduction Congenital heart disease (CHD) is a group of lesions with an incidence of 6-8 per 1000 at birth [1]. Advances in the treatment as well as in early diagnosis have drastically increased the survival rate of this population over the last decades. Therefore, most of these patients currently survive into adulthood, and the number of subjects with congenital heart disease has dramatically increased [2]. Imaging plays a crucial role in the diagnosis and management of CHD, and it is a key component of patient care
* Aurelio Secinaro [email protected] 1
Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
2
Pediatric Cardiology and Pediatric Cardiac Surgery Department, Bambino Gesù Children’s Hospital IRCSS, Rome, Italy
3
Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
4
Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy
5
Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
at all stages [3–5]. From the fetal life onward, imaging is a mainstay defining anatomy and physiology of these conditions, helping to refine management, and guiding prognosis. The main imaging techniques in CHD are echocardiography (Echo), cardiac magnetic resonance (CMR), cardiac computed tomography (CCT), and cardiac catheterization. Due to its portability, wide availability and noninvasive nature, transthoracic echo remains the first-line imaging technique in CHD [6], and especially in the neonatal age, it can define diagnosis and guide management by itself [7]. However, transthoracic echo may be limited by poor acoustic window
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