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Low-Dose Radiation Angiograms Successful in Diagnosing Congenital Lung Lesions in Neonates: Presented at AAP

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- October 28, 2009 -- Low-dose angiograms are as sensitive as standard chest radiation in detecting congenital lung malformations in neonates, researchers reported here at the 2009 American Academy of Pediatrics (AAP) National Conference & Exhibition.

In neonates, congenital lung lesions such as lung parenchyma, arterial supply, or venous drainage may be detected at birth due to respiratory problems or incidentally during pregnancy. Chest radiography is often used to confirm the initial diagnosis.

The long-term risks associated with radiation exposure are especially increased in the paediatric population, especially given that physicians rely more and more on radiation techniques for diagnosis, said Dustin M. Bermudez, MD, Center for Fetal Research, Children's Hospital of Philadelphia, and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Minimising the exposure to radiation, especially in childhood, is of paramount importance, stated Dr. Bermudez, reporting here on October 16.

He and his fellow investigators sought to test their hypothesis that a low-dose radiation computed tomography angiogram (CTA) could be used for diagnosis in a paediatric population. The CTA relies on x-rays and an injected radioactive dye to visualise arteries and detect abnormalities.

The team undertook a retrospective analysis, examining all neonates who had had resection of a congenital lung malformation at their institution between January 2003 and February 2009. The low-dose CTA protocol was implemented in July 2006.

A total of 103 neonates received standard chest CT, while 114 received low-dose CTA. The patient demographics indicated that the patients in the 2 groups had a similar age at surgery, with a mean age of 59 days (standard CT group) and 48 days (CTA group). Similar numbers in each group were diagnosed with congenital cystic adenomatoid malformation of the lung (CCAM): 74 patients in the standard CT group (72%) and 77 in the CTA group (68%).

The dose of radiation was significantly lower for children who underwent low-dose CTA -- an average of 1.1 mSv per child (range, 0.25 to 3.8 mSv) -- compared with an average of 9 mSv in the CCAM group. This translated to a difference of 7.9 mSv less per child, which was significant (P < .01).

Interestingly, the presence of pulmonary sequestrations was more likely to be missed by a standard chest CT scan (n = 3), compared to the low-dose CTA (n = 0), (P < .05).

The investigators concluded that there is a net difference in the total amount of radiation delivered to children who undergo low-dose CTA compared with standard CT, which can help minimise the radiation risk in this very young patient population.

[Presentation Title: Low-Dose Radiation CT Angiograms Are as Accurate as Standard Chest CT in the Diagnosis of Congenital Lung Lesions. Abstract 6708]

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