Comprehensive Evaluation of Tetralogy of Fallot: Superior Diagnostic Performance and Clinical Utility of MDCT Compared to Echocardiography

Original Article

Abstract

Objective: To Assess the Diagnostic Accuracy, Incremental Value and Clinical Impact of Multi-Detector Computed Tomography (MDCT) in Patients with Tetralogy of Fallot compared with Echocardiography.

Methodology: This Cross-sectional analytical study was conducted in the Department of Pediatric Cardiology, MTI, Hayatabad Medical Complex, Peshawar, Pakistan, from January 2024 to December 2025, and included 182 patients with Tetralogy of Fallot. We performed transthoracic echocardiography and contrast-enhanced MDCT on all patients. We evaluated diagnostic performance using sensitivity, specificity, and predictive values against surgical or multidisciplinary consensus. We also considered incremental diagnostic value and clinical impact on management decisions.

Results: MDCT had better sensitivity (96.7%) and specificity (91.2%) than echocardiography (84.6% and 78.4%, respectively). MDCT accurately identified pulmonary artery anatomy in 96.7% of patients, compared with 78.0% on echocardiography. MDCT detected MAPCAs in 50.6% versus 26.4%, coronary anomalies in 25.3% versus 9.9%, and vascular abnormalities in 39.6% versus 18.7%. MDCT showed further clinically significant findings in a significant proportion of cases and influenced surgical or interventional planning in 52.8% of patients, including modification of the operative strategy.

Conclusion: MDCT has greater diagnostic and clinical value than echocardiography for the overall evaluation of Tetralogy of Fallot