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CT of Pediatric Vascular Stents Used to Treat Congenital Heart Disease

Joachim G. Eichhorn1,2, Claudia Jourdan1,3, Sharon L. Hill4, Subha V. Raman5, John P. Cheatham4 and Frederick R. Long6

1 Department of Radiology, Ohio State University College of Medicine, Columbus, OH.
2 Department of Pediatric Cardiology, University Children's Hospital, Im Neuenheimer Feld 153, 69120 Heidelberg, Germany.
3 Department of Pediatric Radiology, University Children's Hospital, Heidelberg, Germany.
4 Heart Center, Columbus Children's Hospital, Columbus, OH.
5 Division of Cardiology, Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus, OH.
6 Children's Radiological Institute, Columbus Children's Hospital, Columbus, OH.


Figure 1
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  		Fig. 1A —Four stents after placement in polyvinyl chloride (PVC) tubes. Three-dimensional MDCT reconstructions and conventional photographs (insets) of Palmaz Genesis (Cordis) in 13-mm tube (A), Intrastent MAX LD (ev3) in 17-mm tube (B), Palmaz XL (Cordis) in 20-mm tube (C), and Intrastent MAX LD in 25-mm tube (D). See also Table 1.

 

Figure 2
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  		Fig. 1B —Four stents after placement in polyvinyl chloride (PVC) tubes. Three-dimensional MDCT reconstructions and conventional photographs (insets) of Palmaz Genesis (Cordis) in 13-mm tube (A), Intrastent MAX LD (ev3) in 17-mm tube (B), Palmaz XL (Cordis) in 20-mm tube (C), and Intrastent MAX LD in 25-mm tube (D). See also Table 1.

 

Figure 3
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  		Fig. 1C —Four stents after placement in polyvinyl chloride (PVC) tubes. Three-dimensional MDCT reconstructions and conventional photographs (insets) of Palmaz Genesis (Cordis) in 13-mm tube (A), Intrastent MAX LD (ev3) in 17-mm tube (B), Palmaz XL (Cordis) in 20-mm tube (C), and Intrastent MAX LD in 25-mm tube (D). See also Table 1.

 

Figure 4
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  		Fig. 1D —Four stents after placement in polyvinyl chloride (PVC) tubes. Three-dimensional MDCT reconstructions and conventional photographs (insets) of Palmaz Genesis (Cordis) in 13-mm tube (A), Intrastent MAX LD (ev3) in 17-mm tube (B), Palmaz XL (Cordis) in 20-mm tube (C), and Intrastent MAX LD in 25-mm tube (D). See also Table 1.

 

Figure 5
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  		Fig. 2 —Measurements of cross-sectional stent strut (double arrow 1) and stent lumen diameter (double arrow 2) and contrast-enhanced in-stent residual lumen (double arrow 3) perpendicular to long axis of stent. Diameter ratio between residual stent lumen and original stent lumen formed basis for grading in-stent stenosis.

 

Figure 6
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  		Fig. 3 —Scatter graph of agreement between MDCT and digital angiography for assessment of in-stent stenosis for mild (n = 40: two stents were scanned, 10 tube settings; data of two observers) and moderate in-stent stenoses (n = 20: one stent). Data are shown in three groups according to tube voltage: {triangleup} = 80, {diamondsuit} = 100, and {circ} = 120 kVp. For moderate stenoses, there were no significant differences found between kVp groups (p values between 0.6 and 0.9). For mild stenoses, there was significant improvement for 100 kVp versus 80 (p = 0.03) and also versus 120 kVp (p = 0.003). Mean and SD of all tube voltages are added.

 

Figure 7
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  		Fig. 4 —Multiplanar 2D MDCT reconstruction images of two stents of different sizes, one with moderate (upper row) and one with mild (lower row) in-stent stenosis show effect of varying tube voltages and currents on image quality.

 

Figure 8
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  		Fig. 5 —Graph shows agreement between MDCT and digital angiography assessment of inner-stent diameters in relation to dose (each data point represents mean of measurements for 10 stents). There was increase in agreement with increase of tube current (80 vs 40 mA, p = 0.02; 120 vs 80 mA, p = 0.04), with exception of 120 kVp, in which decrease was not statistically significant. {diamondsuit} = 80, • = 100, and {blacksquare} = 120 kVp.

 

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