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• W4365505035 abstract "We appreciate the thoughtful commentary in response to our article (1Jenner Z.B. Li P. Kang L. et al.Pediatric intranodal CT lymphangiography with water-soluble contrast medium.J Vasc Interv Radiol. 2022; 33: 1440-1443Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar) from Wong et al (2Wong D. Fung K.F. Chen H.R. Lun K.S. Kan Y.L. Intranodal cone-beam computed tomography lymphangiography with water-soluble iodinated contrast agent for evaluating chylothorax in infants—preliminary experience at a single institution.Pediatr Radiol. 2022; 53: 179-183Crossref PubMed Scopus (3) Google Scholar) about their use of cone-beam computed tomography (CT) for intranodal CT lymphangiography for pediatric patients using water-soluble contrast media. We agree that cone-beam CT is a useful alternative to traditional whole-body CT for this procedure. Cone-beam CT lymphangiography has the clear advantages of same-session intervention and elimination of patient transportation (if necessary). In our study, we utilized fluoroscopy (single-rotation) in 1 patient while the patient was on a whole-body CT scanner, which similarly allowed for real-time evaluation of intranodal injection, reduced the likelihood of needle dislodgment, and documented central lymphatic opacification prior to diagnostic CT image acquisition. Utilizing a helical CT scanner with a mobile C-arm in the room obviated the issues associated with patient transport. Modern angiography systems have cone-beam CT capability, and the fluoroscopic guidance that these systems provide simplifies procedural logistics, as Wong et al (2Wong D. Fung K.F. Chen H.R. Lun K.S. Kan Y.L. Intranodal cone-beam computed tomography lymphangiography with water-soluble iodinated contrast agent for evaluating chylothorax in infants—preliminary experience at a single institution.Pediatr Radiol. 2022; 53: 179-183Crossref PubMed Scopus (3) Google Scholar) reported. Hybrid angio-CT systems, first introduced in 1992, are slowly increasing in availability (3Taiji R. Lin E.Y. Lin Y.M. et al.Combined angio-CT systems: a roadmap tool for precision therapy in interventional oncology.Radiol Imaging Cancer. 2021; 3e210039Crossref PubMed Scopus (7) Google Scholar). Pediatric intranodal CT lymphangiography would be a great application for this hybrid room. Cone-beam CT and the whole-body CT methodology have similar drawbacks, those of iodinated contrast medium administration and radiation exposure. The radiation dose of cone-beam CT and whole-body CT are dependent on the technical factors used and equipment settings; both allow for collimation to allow for imaging a smaller field of view, which helps to limit the overall radiation dose by reducing the volume of tissue imaged during the scan. A potential downside of cone-beam CT, especially in the context of traumatic lymphatic leak, is increased scanning time compared with that with a helical CT scanner. Increased scanning time may lead to increased motion artifacts and, therefore, decreased image quality. The speed of rotation of the large C-arm limits the scanning speed of cone-beam CT. However, the voxel size of cone-beam CT (∼150 μm) is typically smaller than that of whole-body CT systems (∼250 μm) and, thus, can produce higher-resolution CT image data sets under ideal conditions, which can be useful for evaluating small lymphatic structures. In our study, 1 patient was scanned using a high-resolution whole-body CT scanner (Aquilion Precision; Canon, Tokyo, Japan), which was also able to produce 150-μm resolution images for this procedure. Multiplanar reconstructions are rapidly produced on virtually all cone-beam and whole-body systems. In summary, we agree with our colleagues at Hong Kong Children’s Hospital: both cone-beam CT and whole-body CT systems are useful for this delicate lymphangiography procedure in pediatric patients and are viable alternatives to magnetic resonance lymphangiography. This application of hybrid angio-CT rooms may be particularly promising. We thank Wong et al (2Wong D. Fung K.F. Chen H.R. Lun K.S. Kan Y.L. Intranodal cone-beam computed tomography lymphangiography with water-soluble iodinated contrast agent for evaluating chylothorax in infants—preliminary experience at a single institution.Pediatr Radiol. 2022; 53: 179-183Crossref PubMed Scopus (3) Google Scholar) for providing their perspective. Re: Pediatric Intranodal CT Lymphangiography with Water-Soluble Contrast MediaJournal of Vascular and Interventional RadiologyVol. 34Issue 8PreviewWe read with great interest the article by Jenner et al (1) regarding the use of water-soluble contrast computed tomography (CT) lymphangiography as an alternative for the assessment of lymphatic leakage in pediatric patients with a history of congenital heart disease repair. They explained very clearly the limitations of magnetic resonance (MR) imaging lymphangiography and ethiodized lymphangiography and explained how water-soluble contrast CT lymphangiography can be a feasible alternative. Their 2 cases provide a great overview of how this procedure is performed, why this modality is chosen, and the findings that helped guide the management of high-output chylothorax postsurgical repair of congenital heart disease. Full-Text PDF" @default.
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• W4365505035 date "2023-08-01" @default.
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• W4365505035 title "Authors’ Reply: Pediatric Intranodal CT Lymphangiography with Water-Soluble Contrast Media" @default.
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