ARRS 2022 Abstracts


E1911. CTA Image Quality in Pediatric Radiology
  1. Monica Miranda-Schaeubinger; Children's Hospital of Philadelphia
  2. Summer Kaplan; Children's Hospital of Philadelphia; University of Pennsylvania, Perelman School of Medicine
  3. Venkatakrishna Shyam; Children's Hospital of Philadelphia
  4. Michael Acord; Children's Hospital of Philadelphia; University of Pennsylvania, Perelman School of Medicine
  5. Patricia Mecca; Children's Hospital of Philadelphia
  6. Xiaowei Zhu; Children's Hospital of Philadelphia
  7. Srinivasan Abhay; Children's Hospital of Philadelphia; University of Pennsylvania, Perelman School of Medicine
Perceived sub-optimal quality of pediatric abdominal CT angiograms (CTAs) at our institution has hindered confident radiologic assessment and surgical planning by transplant teams. We sought to elucidate substrates that contribute to unacceptable image quality with these studies to inform quality improvement.

Materials and Methods:
Demographic information was collected from medical records, and corresponding CTAs from 2001–2021 were reviewed. Two radiologists performed a subjective review of acceptability of each study with regard to arterial phase (AP) contrast timing, AP mottle, AP streak artifact, portal phase (PP) timing, PP mottle, PP streak artifact, hepatic venous phase (HVP) timing, HVP mottle, and HVP streak artifact. An unacceptable CTA was any CTA with at least one unacceptable characteristic.

We evaluated 87 CTAs. Of these, 23 (26.4%) were acceptable, 64 (73.6%) were unacceptable in at least one category. Within the unacceptable CTA, 38 (43.7%) had unacceptable HVP mottle, 34 (39.1%) had unacceptable PP mottle, 24 (27.6 %) had unacceptable AP mottle, 19 (21.8%) had unacceptable HVP timing. There were significant associations with patient weight as well as age and unacceptability regarding AP mottle (p = 0.000 and 0.0003, respectively) and PP mottle (p = 0.014 and 0.0336). Associations between patient age and unacceptability by HPV timing (p = 0.0203) and HVP streak artifact (p = 0.0061) were also significant. Furthermore, there was a significant difference in hepatic venous phase slice thickness and acceptability (p = 0.046). Acceptable CTAs tend to have thicker hepatic venous phase slices compared to unacceptable CTAs. Thickness in other phases showed a similar trend, but it was not statistically significant.

Quantum mottle in the hepatic venous phase was the most frequently identified source of CTA unacceptability. Given that patient weight also correlated with unacceptable mottle, potential interventions for quality improvement purposes include implementing thicker slices and adjustments to reduce mottle and increase photon flux, taking into consideration patients’ age and weight. Obtaining adequate image quality in pediatric abdominal CTA imaging can be challenging. We determine characteristics of image quality that may be relevant in protocol optimization.