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Pediatric Radiology
Published in: Pediatric Radiology 8/2021

01-07-2021 | Sudden Cardiac Death | Original Article

Accuracy of computed tomography angiography and structured reporting of high-risk morphology in anomalous aortic origin of coronary artery: comparison with surgery

Authors: Rajesh Krishnamurthy, Prakash M. Masand, Siddharth P. Jadhav, Silvana Molossi, Wei Zhang, Hitesh M. Agrawal, Carlos M. Mery

Published in: Pediatric Radiology | Issue 8/2021

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Abstract

Background

Morphological features including interarterial course, intramural course, high ostial location and slit-like ostium are presumed risk factors for sudden cardiac death in children with anomalous aortic origin of the coronary artery (AAOCA). To facilitate clinical risk stratification, the diagnostic accuracy of CT angiography for individual risk factors in the setting of AAOCA must be established.

Objective

We assessed diagnostic accuracy of standardized CT angiography interpretation for morphological characteristics that might determine risk in children with AAOCA by comparing them to surgical findings.

Materials and methods

We created a standardized protocol for CT angiography of AAOCA and retrospectively evaluated diagnostic performance in 25 consecutive surgical patients. Relevant morphological variables in AAOCA were assessed by three independent blinded readers, with surgery as the reference standard. We used Cohen kappa coefficients and accuracies to assess agreement between readers and surgical findings, and we calculated intraclass correlation coefficients to compare length of the intramural course.

Results

CT angiography correctly identified AAOCA in all patients. For the three readers, accuracies for detecting ostial stenosis were 84%, 94% and 96%; for high ostial origin, accuracies were 76%, 78% 82%; for intramurality using the peri-coronary fat sign, accuracies were 98%, 96% and 92%; and for intramurality using oval shape of coronary artery, accuracies were 98%, 94% and 92%. The intraclass correlation coefficients (ICCs) for predicting intramural length among the three readers were 0.67, 0.75 and 0.81 using peri-coronary fat, and 0.69, 0.50 and 0.81 using oval shape, respectively.

Conclusion

CT angiography reliably identified AAOCA in all children and detected the presence of intramurality with high accuracy.
Appendix
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Metadata
Title
Accuracy of computed tomography angiography and structured reporting of high-risk morphology in anomalous aortic origin of coronary artery: comparison with surgery
Authors
Rajesh Krishnamurthy
Prakash M. Masand
Siddharth P. Jadhav
Silvana Molossi
Wei Zhang
Hitesh M. Agrawal
Carlos M. Mery
Publication date
01-07-2021
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 8/2021
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-021-05011-0

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