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Gradual Pulmonary Artery Enhancement: New Sign of Septal Defects on CT

¹ Department of Radiology, 407, Taichung Veterans General Hospital, No. 160, Section 3, Taichung Harbor Rd., Taichung, Taiwan, R.O.C.
² Faculty of Medicine, Medical College of Chung Shan Medical University, Taiwan, R.O.C.
³ Department of Medicine, National Yang Ming University, Taiwan, R.O.C.
⁴ Institute of Clinical Medicine, National Yang Ming University, Taiwan, R.O.C.
⁵ Section of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
⁶ Section of Cardiovascular Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.

View larger version (28K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —7-year-old boy with Kawasaki disease and negative cardiac CT. Measurement of CT attenuation values on serial bolus-tracking images obtained at level of carina. A and B are 1-cm2 regions of interest in main pulmonary artery and ascending aorta. Software generated time–attenuation curve. We recorded CT numbers at every second for further analysis.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Comparison of time–attenuation parameters among control group and subgroups. MSPA = maximal slope of pulmonary enhancement, ASD = atrial septal defect, VSD = ventricular septal defect, bar = mean ± 1 SD. Across groups, MSPA values are decreasing (A), time to MSPA (tMSPA) values are lengthening (B), area between curves of pulmonary artery and aorta values are decreasing (C), and mean ratio of pulmonary artery and aortic enhancement (PA/AO) values are decreasing (D).

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Comparison of time–attenuation parameters among control group and subgroups. MSPA = maximal slope of pulmonary enhancement, ASD = atrial septal defect, VSD = ventricular septal defect, bar = mean ± 1 SD. Across groups, MSPA values are decreasing (A), time to MSPA (tMSPA) values are lengthening (B), area between curves of pulmonary artery and aorta values are decreasing (C), and mean ratio of pulmonary artery and aortic enhancement (PA/AO) values are decreasing (D).

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Comparison of time–attenuation parameters among control group and subgroups. MSPA = maximal slope of pulmonary enhancement, ASD = atrial septal defect, VSD = ventricular septal defect, bar = mean ± 1 SD. Across groups, MSPA values are decreasing (A), time to MSPA (tMSPA) values are lengthening (B), area between curves of pulmonary artery and aorta values are decreasing (C), and mean ratio of pulmonary artery and aortic enhancement (PA/AO) values are decreasing (D).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Comparison of time–attenuation parameters among control group and subgroups. MSPA = maximal slope of pulmonary enhancement, ASD = atrial septal defect, VSD = ventricular septal defect, bar = mean ± 1 SD. Across groups, MSPA values are decreasing (A), time to MSPA (tMSPA) values are lengthening (B), area between curves of pulmonary artery and aorta values are decreasing (C), and mean ratio of pulmonary artery and aortic enhancement (PA/AO) values are decreasing (D).

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Time–attenuation curves in control group and subgroups. Aorta = , pulmonary artery = . Control curves show typical pulmonary artery enhancement pattern with early rising and subsequent plateau. Time–attenuation parameters, including maximal slope of pulmonary enhancement (MSPA), time to maximal slope of pulmonary enhancement (tMSPA), area between curves of pulmonary artery and aorta (ABC), and mean ratio of pulmonary artery and aortic enhancement (PA/AO), are illustrated.

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Time–attenuation curves in control group and subgroups. Aorta = , pulmonary artery = . Curves for patient with atrial septal defect (ASD) show loss of early rising pattern.

View larger version (6K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Time–attenuation curves in control group and subgroups. Aorta = , pulmonary artery = . Curves for patient with ventricular septal defect (VSD) show loss of both early rising pattern and subsequent plateau. Enhancement curves for pulmonary artery and aorta are closer than in B.

View larger version (6K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Time–attenuation curves in control group and subgroups. Aorta = , pulmonary artery = . Curves for patient with ASD and VSD show nearly overlapping enhancement curves for pulmonary artery and aorta. This finding indicates large shunt volume between left and right sides of heart.

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