Aya Kino1, Evan J Zucker2, Anita Honkanen3, Jerry Kneebone2, Jia Wang4, Frandics Chan2, Beverley Newman2. 1. Department of Radiology, Lucile Packard Children's Hospital at Stanford University, 725 Welch Road, Room 1677 MC 5913, Stanford, CA, 94304, USA. Akino2@stanford.edu. 2. Department of Radiology, Lucile Packard Children's Hospital at Stanford University, 725 Welch Road, Room 1677 MC 5913, Stanford, CA, 94304, USA. 3. Department of Anesthesia, Lucile Packard Children's Hospital at Stanford University, Stanford, CA, USA. 4. Environmental Health and Safety, Stanford University, Stanford, CA, USA.
Abstract
BACKGROUND: General anesthesia (GA) or sedation has been used to obtain good-quality motion-free breath-hold chest CT scans in young children; however pulmonary atelectasis is a common and problematic accompaniment that can confound diagnostic utility. Dual-source multidetector CT permits ultrafast high-pitch sub-second examinations, minimizing motion artifact and potentially eliminating the need for a breath-hold. OBJECTIVE: The purpose of this study was to evaluate the feasibility of free-breathing ultrafast pediatric chest CT without GA and to compare it with breath-hold and non-breath-hold CT with GA. MATERIALS AND METHODS: Young (≤3 years old) pediatric outpatients scheduled for chest CT under GA were recruited into the study and scanned using one of three protocols: GA with intubation, lung recruitment and breath-hold; GA without breath-hold; and free-breathing CT without anesthesia. In all three protocols an ultrafast high-pitch CT technique was used. We evaluated CT images for overall image quality, presence of atelectasis and motion artifacts. RESULTS: We included 101 scans in the study. However the GA non-breath-hold technique was discontinued after 15 scans, when it became clear that atelectasis was a major issue despite diligent attempts to mitigate it. This technique was therefore not included in statistical evaluation (86 remaining patients). Overall image quality was higher (P=0.001) and motion artifacts were fewer (P<.001) for scans using the GA with intubation and recruitment technique compared to scans in the non-GA free-breathing group. However no significant differences were observed regarding the presence of atelectasis between these groups. CONCLUSION: We demonstrated that although overall image quality was best and motion artifact least with a GA-breath-hold intubation and recruitment technique, free-breathing ultrafast pediatric chest CT without anesthesia provides sufficient image quality for diagnostic purposes and can be successfully performed both without and with contrast agent in young infants.
BACKGROUND: General anesthesia (GA) or sedation has been used to obtain good-quality motion-free breath-hold chest CT scans in young children; however pulmonary atelectasis is a common and problematic accompaniment that can confound diagnostic utility. Dual-source multidetector CT permits ultrafast high-pitch sub-second examinations, minimizing motion artifact and potentially eliminating the need for a breath-hold. OBJECTIVE: The purpose of this study was to evaluate the feasibility of free-breathing ultrafast pediatric chest CT without GA and to compare it with breath-hold and non-breath-hold CT with GA. MATERIALS AND METHODS: Young (≤3 years old) pediatric outpatients scheduled for chest CT under GA were recruited into the study and scanned using one of three protocols: GA with intubation, lung recruitment and breath-hold; GA without breath-hold; and free-breathing CT without anesthesia. In all three protocols an ultrafast high-pitch CT technique was used. We evaluated CT images for overall image quality, presence of atelectasis and motion artifacts. RESULTS: We included 101 scans in the study. However the GA non-breath-hold technique was discontinued after 15 scans, when it became clear that atelectasis was a major issue despite diligent attempts to mitigate it. This technique was therefore not included in statistical evaluation (86 remaining patients). Overall image quality was higher (P=0.001) and motion artifacts were fewer (P<.001) for scans using the GA with intubation and recruitment technique compared to scans in the non-GA free-breathing group. However no significant differences were observed regarding the presence of atelectasis between these groups. CONCLUSION: We demonstrated that although overall image quality was best and motion artifact least with a GA-breath-hold intubation and recruitment technique, free-breathing ultrafast pediatric chest CT without anesthesia provides sufficient image quality for diagnostic purposes and can be successfully performed both without and with contrast agent in young infants.
Authors: Michael M Lell; Matthias May; Paul Deak; Sedat Alibek; Michael Kuefner; Axel Kuettner; Henrik Köhler; Stephan Achenbach; Michael Uder; Tanja Radkow Journal: Invest Radiol Date: 2011-02 Impact factor: 6.016
Authors: Seong Ho Kim; Young Hun Choi; Hyun-Hae Cho; So Mi Lee; Su-Mi Shin; Jung-Eun Cheon; Woo Sun Kim; In-One Kim Journal: Eur Radiol Date: 2015-08-09 Impact factor: 5.315
Authors: Gerardo Tusman; Stephan H Böhm; Alejandro Tempra; Fernando Melkun; Eduardo García; Elsio Turchetto; Paul G H Mulder; Burkhard Lachmann Journal: Anesthesiology Date: 2003-01 Impact factor: 7.892
Authors: A Ioana Cristea; Clement L Ren; Reshma Amin; Laurie C Eldredge; Jonathan C Levin; Parevi P Majmudar; Anne E May; Rebecca S Rose; Michael C Tracy; Karen F Watters; Julian Allen; Eric D Austin; Mary E Cataletto; Joseph M Collaco; Robert J Fleck; Andrew Gelfand; Don Hayes; Marcus H Jones; Sheila S Kun; Erica W Mandell; Sharon A McGrath-Morrow; Howard B Panitch; Rizwana Popatia; Lawrence M Rhein; Alejandro Teper; Jason C Woods; Narayan Iyer; Christopher D Baker Journal: Am J Respir Crit Care Med Date: 2021-12-15 Impact factor: 21.405
Authors: Jette J Bakhuizen; Helen Hanson; Karin van der Tuin; Fiona Lalloo; Marc Tischkowitz; Karin Wadt; Marjolijn C J Jongmans Journal: Fam Cancer Date: 2021-06-25 Impact factor: 2.446