Artificial intelligence (AI) is increasingly integrated into radiology, but pediatric imaging remains underrepresented in implementation studies. To assess the current status, barriers, and enablers of AI adoption in Pediatric Radiology from a global leadership perspective. A cross-sectional international survey of department leaders and division chiefs from pediatric radiology centers worldwide was conducted. The questionnaire included 14 items across domains of AI deployment, enablers, barriers, ethical concerns, stakeholder involvement, and future directions. Descriptive statistics were used for analysis. Eighteen institutions completed the survey (69

Objectives:Reverse Potts shunt is a promising yet high-risk therapy for pediatric pulmonary arterial hypertension. Postoperative hemodynamics is critically influenced by shunt configuration but is difficult to predict. This study aimed to quantify the effects of shunt size and location on hemodynamics to guide surgical planning. Methods:Based on a patient-specific model, four postoperative models with two different shunt locations [left pulmonary artery (LPA)-descending aorta (DAO) and pulmonary artery bifurcation-aortic arch] and three conduit sizes (4, 5, and 6 mm) were created. The direct Potts shunt model was created by a direct side-to-side anastomosis between the LPA and DAO with a 6-mm circular opening. Quantitative parameters including the shunt ratio (SR), which was defined as the percentage of the shunt flow rates to the total pulmonary inflow rate, lower limb oxygen saturation, and pressure were analyzed. Results:Increasing the shunt size from 4 mm to 6 mm elevated the SR from 6.01% to 9.80%, concurrently reducing lower limb oxygen saturation from 89.57% to 86.52%. When taking 11,000 Pa as the threshold, this increased SR resulted in a reduction of the high-pressure area from 17.32% of the total pulmonary artery area to almost zero. Meanwhile, the high-pressure area on the aorta expanded from 8.72% of the total aortic area to 14.94%. These results indicated a reduction in the right ventricular afterload and an increase in the left ventricular afterload. Notably, a 6-mm shunt at the pulmonary artery bifurcation yielded a significantly larger SR than at the LPA (9.80% vs. 2.68%), which is attributed to a higher pressure gradient at the pulmonary artery bifurcation (1,201 Pa vs. 162 Pa). Conclusion:The shunt location had a greater impact on the SR than shunt size within the 4 mm-6 mm range in this specific case. A 6-mm shunt at the pulmonary artery bifurcation yielded a significantly larger SR than at the LPA, which is attributed to the higher preoperative pressure gradient at the bifurcation site. Left heart function is as critical as right heart function in maintaining pressure balance and determining outcomes, as the shunt flow increases the left ventricular afterload.

Purpose To evaluate whether left atrial (LA) function assessed with cardiac MRI provides incremental prognostic value beyond biventricular function in children with repaired tetralogy of Fallot (rTOF). Materials and Methods In this prospective study, pediatric participants with rTOF were consecutively recruited between August 2019 and December 2021 and healthy controls from July 2017 to August 2018. All participants underwent cardiac MRI. Measurements included LA size, ejection fraction (EF), strain, and strain rate across reservoir, conduit, and pump phases, and biventricular volumes, mass, and global longitudinal strain (GLS). Late gadolinium enhancement was assessed in rTOF. End point events were heart failure hospitalization and reoperation. Cox regression analysis was performed. Model performance was assessed using Harrell concordance index, integrated discrimination improvement, and net reclassification improvement. Results Seventy-eight participants with rTOF (mean age, 10.73 years ± 3.66 [SD]; 47 male) and 30 controls (mean age, 11.06 years ± 2.97; 21 male) were included. Compared with controls, participants with rTOF demonstrated LA dysfunction, with lower reservoir EF, strain, and strain rate, lower conduit EF and strain, and higher pump EF, while biventricular GLS remained normal. Over a median follow-up of 2 years, impaired LA conduit strain (<15.83%), impaired right ventricular (RV) GLS (<22.66%), and higher end-systolic volume index were independently associated with end point events (hazard ratio = 4.72, 2.75, and 1.02, respectively). Adding impaired LA conduit strain into the RV GLS model increased the concordance index from 0.74 to 0.82 (P < .001) with an integrated discrimination improvement of 0.13 (P = .006) and net reclassification improvement of 0.89 (P < .001). Conclusion In pediatric rTOF with preserved ventricular EF and GLS, LA dysfunction at cardiac MRI was evident. Incorporating LA conduit strain alongside established RV functional parameters improved prognostic assessment during follow-up. Keywords: Pediatrics, MR Imaging, Cardiac, Left Atrium, Right Ventricle, Congenital, Outcomes Analysis, Cardiac MRI, Congenital Heart Disease, Tetralogy of Fallot, Left Atrial Function Supplemental material is available for this article. © RSNA, 2026.

Background Few data exist on practice trends for cardiovascular magnetic resonance (CMR) in pediatric and congenital heart disease (CHD). The Society for Cardiovascular Magnetic Resonance addressed this gap by conducting an international survey of CMR sites in 2014 and 2018. We now report the most recent survey results from 2024. Methods Surveys with 31 (2014), 33 (2018), and 41 (2024) items were sent to all SCMR members. One response per center was collected. Results There were 93 centers that responded in 2014, 83 in 2018, and 124 in 2024. The following results are per center and data from 2014, 2018, and 2024 are separated by dashes. The median annual number of pediatric/CHD CMR cases was 183–209–250. The median number of CMR scanners was 2–2–2 (range, 1–8) with 58–63–53% using only 1.5T scanners and 4–4–3% using only 3T. CMR examinations were performed in infants (<1 year old) in 74%–76%–90% and sedation and/or anesthesia was used in 84%–86%–94% of the centers. The mean number of attendings/staff reading CMRs was 3.7–2.6–2.9. Combining attending/staff physicians from all centers, 52–61–62% were pediatric or adult cardiologists, and 47–38–37% were pediatric or adult radiologists. The median annual case volume per physician per center was 54–86–76. The median number of technologists was 4–5–4. The median scanner time allocated for a non-sedated examination was 75–75–75minutes (range, 30–120minutes). Among the 14 centers responding to all 3 surveys, the mean annual case volume was 380–500–588, with 82% of centers experiencing a sequential increase in volume with each survey. All of these 14 centers were in the United States and for them, the mean time for an attending/staff physician to perform a typical CMR examination, including supervision and reporting, was 150–153–154minutes, and the median scanner time allocated per ex per year was 92 in the amination for non-sedation cases remained unchanged at 90–90–90minutes. Conclusion These survey data provide a unique and comprehensive view of CMR practice in pediatric and CHD across centers worldwide. This information is useful for internal benchmarking, resource allocation, addressing practice variation, quality improvement initiatives, and identifying unmet needs.

ObjectiveTo evaluate the feasibility of ultra–low tube voltage (70 kV) cardiac CT angiography (CTA) with weight-adapted iodine delivery in neonates and to compare image quality, coronary visibility, radiation exposure, and iodine delivery with those of a conventional 80-kV protocol.MethodsThis retrospective study included 125 neonates with congenital heart disease who underwent prospectively ECG-triggered cardiac CTA using a 256-row CT scanner. Patients were divided into an 80-kV group reconstructed with 50% adaptive statistical iterative reconstruction-V (ASIR-V) (n = 61) and a 70-kV group reconstructed with 70% ASIR-V (n = 64). Both protocols used standardized weight-adapted iodine delivery (450 mg I/kg). Subjective and objective image quality, coronary artery visibility, radiation dose, and iodine delivery were compared between groups.ResultsOverall interobserver agreement for subjective image quality assessment was excellent (κ = 0.815). Subjective image quality scores were comparable between the two groups across most coronary segments, with no significant differences in overall image quality (3.98 ± 1.04 vs. 3.95 ± 1.05, P = 0.545). Objective image quality parameters, including CT attenuation, image noise, signal-to-noise ratio, and contrast-to-noise ratio, also showed no significant differences between groups (all P > 0.05). Coronary artery visibility remained high in both groups, with overall visibility rates exceeding 89%. Importantly, distal coronary segments remained diagnostically assessable in approximately 75% of cases under the 70-kV protocol. Compared with the 80-kV protocol, the 70-kV protocol achieved a 24% reduction in effective radiation dose (0.32 ± 0.05 vs. 0.42 ± 0.06 mSv, P < 0.001) without increasing iodine delivery.ConclusionsUltra-low tube voltage (70 kV) cardiac CT with weight-adjusted iodine delivery is feasible for neonatal imaging and can substantially reduce radiation exposure while preserving coronary artery image quality and visibility. This approach may help achieve a more balanced trade-off among image quality, radiation dose, and contrast administration in neonatal cardiac CT examinations.

Background There are few studies on the brain structure of preterm infants based on low-grade intraventricular hemorrhage. The purpose of this study was to report changes in total and regional brain structure abnormalities in preterm neonates (PN) with low-grade intraventricular hemorrhage (grades I and II) and no other associated MRI abnormalities, and to correlate these changes with gestational age (GA). Methods We examined 76 preterm neonates (26 with low-grade IVH and 50 without IVH) who showed no focal abnormalities on magnetic resonance imaging (MRI) at term-equivalent age. The structural assessment of the brain involves measuring the surface area, thickness, average curvature, and volume of different regions. Retrospective analysis of brain magnetic resonance images of 25 healthy full-term infants and comparison with premature newborns, whose age after postmenstrual was similar. Results Compared with the control preterm infants, the infants with low-grade IVH had decreases in the following:1) Total brain surface area;2) the surface area in Orbitofrontal-Med Right; 3) brain volume in Right Orbitofrontal-Med and Right Hippocampus and Right Thalamus. Conclusions Our study reveals the potential harmful effects of low-grade IVH on surface area and volume development in preterm infants compared to those without IVH at term-equivalent age, underscoring its clinical significance for neurodevelopment in infants with low-grade IVH.

BACKGROUND:T1, T2, T1ρ and fat fraction (FF) are important parameters for diagnosing various pathological changes in the myocardium. However, existing methods either require repeated breath-holds to quantify multiple parameters, or rely on complex image reconstruction to remove artifacts arising from highly undersampled acquisition. To address this technical gap, a free-breathing Dixon-MultiMap technique is proposed to allow for simultaneous myocardial T1, T2, T1ρ and FF mapping in a single scan with conventional single-shot Cartesian acquisition. METHODS:Dixon-MultiMap employs electrocardiogram-triggered, single-shot dual-echo Cartesian acquisition over 14 consecutive cardiac cycles. A hybrid dual-echo acquisition scheme is designed to acquire four-echo images within a short cardiac acquisition window in the first two cardiac cycles, which are used to obtain FF and B0 field maps with water-fat separation. The derived B0 map is used as prior information for dual-echo water-fat separation of the multi-contrast images acquired in the following cardiac cycles. Subsequently, dictionary matching is performed on the water images for multi-parameter mapping, accounting for spin-history B1+ inhomogeneities. Dixon-MultiMap was optimized through simulations and validated in phantoms, 13 healthy volunteers, and three patients with suspected hypertrophic cardiomyopathy. RESULTS:In phantoms, Dixon-MultiMap showed strong correlation with reference methods for measuring T1, T2, T1ρ and FF (R² > 0.96). In healthy subjects, Dixon-MultiMap achieved robust water-fat separation, yielding FF comparable to the conventional multi-echo method. Compared with separate breath-hold mapping techniques, Dixon-MultiMap yielded significantly higher T1 values (1348 ± 33 ms vs. 1159 ± 28 ms, p < 0.001), comparable T2 values (46.4 ± 1.7 ms vs. 45.4 ± 1.5 ms, p = 0.96), and a small but statistically significant increase in T1ρ values (55.8 ± 2.6 ms vs. 53.0 ± 1.8 ms, p = 0.01). Pathological changes detected by Dixon-MultiMap were consistent with those identified using conventional mapping techniques in the three patients. CONCLUSION:The proposed Dixon-MultiMap allows for simultaneous myocardial T1, T2, T1ρ and FF mapping in a free-breathing acquisition of 14 cardiac cycles. Water-fat partial volume was resolved by water-fat separation in Dixon-MultiMap, which improved the accuracy of multi-parameter estimation.

RATIONALE AND OBJECTIVES:Dextro-Transposition of the great arteries (d-TGA), the second most common cyanotic congenital heart defect, requires early risk stratification to identify high-risk arterial switch operation (ASO) patients for long-term prognosis. The aim of this study was to 1) determine biventricular strain and rapid long-axis strain (RLAS) could detect impaired biventricular mechanical in D-TGA patients and 2) establish and validate strain-based prognostic models for improved risk stratification and prediction of composite adverse events. MATERIALS AND METHODS:All patients with D-TGA were divided into training test set and external test set who underwent cardiovascular magnetic resonance (CMR) examination were included in the study. The composite adverse events were defined as complications that necessitated reintervention by echocardiography after CMR. Cardiac function and strain variables were initially considered for inclusion in three models. L1 regularization feature selection was constrained to a maximum of five variables. Its predictive performance was evaluated using the integrated area under the receiver operating characteristic curve (AUC). RESULTS:This study recruited 52 patients in the training set and 20 in the external test set. The primary adverse events were observed in 22 patients (42.3%) and five patients (25%). Compared with controls, the training set patients had significantly greater right ventricle (RV) global circumferential strain (GCS) (-16.32±3.40 vs. -9.41±2.89, p <0.001) and RV GRS (26.93±7.49 vs. 15.03±5.02, p < 0.001) and had significantly reduced left ventricle (LV) atrioventricular junction longitudinal strain (AJLS) (-17.32±3.62 vs. -19.87±2.93, p = 0.033). LV AJLS >18% had significant risk stratification of experiencing composite adverse events (p = 0.004) in the training set group. The model 3 yielded higher diagnostic performance than the other models (AUC=0.87,95% CI:0.83,0.93) in the training set. The model 3 (AUC=0.91, 95% CI:0.87,0.92) integrating biventricular strain and RLAS demonstrated excellent prognostic performance compared with model 1 (AUC=0.71, 95% CI:0.66,0.74) and model 2(AUC=0.67, CI:0.62,0.74) in external set group. CONCLUSION:LV AJLS and RV GCS were found to be independent predictors of composite adverse events. LV AJLS had significant risk stratification of experiencing composite adverse events. The model integrating biventricular strain and RLAS demonstrated excellent prognostic performance compared with traditional models in asymptomatic D-TGA patients.

BACKGROUND:Infantile idiopathic pulmonary arterial hypertension complicated by recurrent episodes of pulmonary hypertensive crisis is an extremely rare and critical condition with high mortality. CASE SUMMARY:We present the case of a 5-month-old infant with a pulmonary hypertension crisis refractory to medical therapy, who underwent successful treatment with an emergency reversed Potts shunt (RPS), along with postoperative venopulmonary extracorporeal membrane oxygenation (V-P ECMO) support. DISCUSSION:From an imaging perspective, the mechanism by which RPS improves symptoms in patient with sustained pulmonary hypertension crises is explained. Additionally, this is the first reported case of successful postoperative use of V-P ECMO support after RPS. TAKE-HOME MESSAGES:It is important to recognize the importance of RPS and V-P ECMO in the treatment of pulmonary hypertension crises. By comparing pre- and postoperative imaging data, the mechanism by which RPS improves cardiac function is better understood.

Vortex ring evolution in confined asymmetric geometries is critical to biological and engineering flows, yet the combined effects of confinement and asymmetry introduce dynamics not captured by studies of either factor alone. This study employs numerical simulations to investigate the three-dimensional evolution of vortex rings under such combined conditions, focusing on the roles of eccentricity (epsilon), Reynolds number (Re), and stroke ratio (L/D-0). The evolution of the primary vortex ring (PVR) before transition into turbulence proceeds through three stages: symmetric growth, asymmetric inclination, and reorientation toward the confinement axis. The inclination arises from asymmetric interactions between the PVR and the boundaries. This interaction generates a boundary vortex ring (BVR) of unequal strength on the near-wall and far-wall sides, causing a differential circulation decay that drives the inclination. The reorientation stage is initiated as the PVR-BVR interaction strengthens with the growing inclination. This interaction promotes vorticity annihilation between opposite-signed segments of the PVR, and it is this annihilation-induced circulation loss that primarily redirects the vortex trajectory. Based on the slug model and the circulation-decay model for confined symmetric vortex rings, a scaling model is developed that quantitatively links the asymmetric circulation decay to the evolving inclination angle, showing good agreement with the simulations. The present study reveals the evolution and dynamics of vortex rings under confined asymmetric region, providing insight into vortex-mediated transport and dissipation in environments such as intracardiac filling.

Background The Fontan procedure is a surgical intervention designed for patients with single ventricle physiology, wherein the systemic venous return is redirected into the pulmonary circulation, thereby facilitating passive pulmonary blood flow without the assistance of ventricular propulsion. Consequently, long-term follow-up of individuals who have undergone the asymptomatic Fontan procedure is essential. Objectives The aims of this investigation were to: 1) examine the impact of flow components and kinetic energy (KE) parameters on hemodynamic disturbances in asymptomatic Fontan patients and control group; 2) Assess left ventricular diastolic dysfunction through the analysis of 4D flow parameters across different Fontan sub-groups; 3) Compare intracardiac flow parameters among Fontan sub-groups based on morphological features of the left ventricle (LV) and right ventricle (RV). Methods Twenty-five Fontan patients (mean age: 10 ± 3 years, male/female: 15/10) and fourteen control subjects (mean age: 10 ± 2 years, male/female: 8/6) were recruited retrospectively for the study. The Fontan patients were further categorized into three groups based on their ventricular function: left ventricular (LV), right ventricular (RV), and biventricular (BiV). Each participant underwent cardiovascular magnetic resonance (CMR) imaging, including cine and 4D flow sequences on a 3.0 T scanner. Ventricular flow components and KE were assessed using 4D flow. The study utilized cine images to analyze cardiac function and inter-ventricular mechanical dyssynchrony. Echocardiography evaluated functional ventricular diastolic dysfunction. Results Fontan patients had a higher median functional single ventricle (FSV) residual volume compared to controls (28 % vs. 23 %, P = 0.034), with lower median FSV direct flow (32 % vs. 40 %, P = 0.005) and delayed ejection flow (17 % vs. 24 %, P = 0.024). The parameters of FSV normalized to the ventricular end-diastolic volume (KEiEDV) were found to be significantly lower in Fontan patients (all P < 0.05). In both left ventricle (LV) and biventricular (BiV) Fontan subgroups, direct flow was identified as an independent predictor of LV diastolic dysfunction (AUC=0.76, Sensitivity=86 %, Specificity=70 %). Furthermore, residual volume and E-wave KEiEDV were observed to be significantly different between LV and right ventricle (RV) Fontan subgroups. Conclusions The altered flow pattern and reduced kinetic energy observed in Fontan patients may indicate hemodynamic disturbances and compromised ventricular filling. Reduced direct flow is associated with LV diastolic dysfunction in LV and BiV Fontan subgroups. Systemic LV exhibited a more efficient intracardiac flow pattern compare with systemic RV in Fontan patients.

Rhabdomyosarcoma represents a prevalent type of soft tissue sarcoma encountered in pediatric patients. Despite multimodal intensified therapies encompassing surgical intervention, chemotherapy, and radiotherapy, the prognosis for patients with high-risk rhabdomyosarcoma remains notably unfavorable. To date, no definitive and efficacious molecularly targeted therapies have been established. This report describes the first documented case of a rhabdomyosarcoma patient harboring a positive BCR-ABL1 fusion gene. At the time of initial diagnosis, the patient presented with a primary tumor in the right thigh and extensive metastatic involvement affecting both lungs, pleura, mediastinum, pelvic cavity, and the right inguinal region, resulting in the classification of the case as high-risk. In addition to conventional multimodal therapy, early intervention using tyrosine kinase inhibitors was implemented, leading to the achievement of an early complete response.

This study proposes a practical approach to assessing the need for and determining the transitioning parameters from age-specific to size-specific dose protocols in paediatric head computed tomography examinations. It was designed to begin with the two different age-specific protocols currently applied on paediatric patients of 1 y <= age <= 6 y (21.34 mGy) and those of age >6 y (34.73 mGy). One characteristic size (HDthreshold) was found by measuring anteroposterior head diameter on historical topograms and used with age to set 135 cases into four groups for investigation (A, <= 6y, <= HDthreshold; B, <= 6y, >HDthreshold; C, >6y, <= HDthreshold; and D, >6 y, >HDthreshold). The image quality was compared in both subjective and objective manners. Results suggest patients in Group C may have received a potential overdose (38%), while the exposure setting for Group D may replace that for B. The proposed strategy was sufficient to assess the necessity and determine the transitioning parameters from age- to size-specific dose protocols.

Tetralogy of Fallot is the most prevalent cyanotic congenital heart disease, requiring lifelong multimodality non-invasive cardiac imaging, such as echocardiography, cardiothoracic computed tomography, and cardiac magnetic resonance imaging. As imaging techniques continuously evolve and are gradually integrated into clinical practice, there is a critical need to update multimodality imaging protocols. Over the last two decades, cardiothoracic computed tomography imaging techniques have advanced remarkably, significantly enhancing its role in evaluating patients with tetralogy of Fallot. In this review, we describe contemporary multimodality non-invasive cardiac imaging protocols for tetralogy of Fallot, emphasizing the expanding role of cardiothoracic computed tomography. Additionally, we present standardized reporting forms designed to facilitate the clinical adoption of these protocols.

Background Pulmonary vein stenosis (PVS) continues to be a major complication after surgical repair of total anomalous pulmonary venous connection (TAPVC). Recent studies suggest that the morphology of pulmonary venous confluence and the left atrium (LA) is associated with PVS. However, there are limited data on the prognostic value of integrating quantitative confluence-atrial morphology into risk stratification. Objectives This study sought to evaluate the prognostic impact of novel imaging metrics derived from 3-dimensional (3D) computed tomography angiography (CTA) modeling on postsurgical PVS (PPVS) in the supracardiac TAPVC (sTAPVC) setting. Methods Patients undergoing sTAPVC repair in 2017 to 2022 from 3 centers were retrospectively reviewed. Study investigators developed 3D CTA modeled geometric features to quantify confluence-atrial morphology that were analyzed with regard to PPVS. Results Of the 162 patients (median age 61 days; 55% having preoperative pulmonary venous obstruction [prePVO]) included, 47 (29%) with PPVS at a median of 1.5 months ([quartile 1-quartile 3: 1.5-3.0 months]). In the univariable analysis, the indexed total volume of the LA and confluence (iTVLC) and the ratio of the corresponding confluence length to the mean distance between the LA and confluence (CCL/mDBLC ratio) were significantly associated with PPVS. In a multivariable model adjusting for prePVO and age, the iTVLC and CCL/mDBLC ratio independently predicted PPVS (HR: 1.15; 95% CI: 1.06-1.25; and HR: 1.20; 95% CI: 1.08-1.35, respectively, all P < 0.01). Specifically, an iTVLC ≥20 cm3/m2 and a CCL/mDBLC ratio ≥7.7 were significantly associated with a reduced risk of PPVS. Conclusions Quantification of 3D confluence-atrial morphology appears to offer a deeper and better metric to predict PPVS in patients with sTAPVC.

Cardiovascular magnetic resonance (CMR) imaging is routinely performed for assessing right ventricular (RV) systolic but not diastolic function. We aimed to investigate CMR-based assessment of RV diastolic function in pediatric patients with repaired tetralogy of Fallot (rTOF), compared to transthoracic echocardiography (TTE) measurements. A total of 130 consecutive pediatric patients with rTOF who underwent clinically indicated CMR and same-day TTE were included. Forty-three controls were recruited. Phase-contrast images were used to measure trans-tricuspid valve flow velocities during early (E) and late diastolic (A) phases (measured in cm/s). Feature tracking of the tricuspid annulus was performed to derive early (e′) and late diastolic (a′) myocardial velocities (measured in cm/s). RV diastolic function was evaluated by E/A ratio, E/e′ ratio, and E-wave deceleration time (measured in milliseconds). Regression analyses were utilized to identify potential variables associated with RV diastolic dysfunction (DD). The performance of CMR-derived parameters in diagnosing RV DD was assessed using receiver-operating characteristic analyses. Good agreement was found between CMR and TTE measurements (ICC 0.70–0.89). Patients with RV DD (n = 67) showed significantly different CMR-derived parameters including E and e′ velocities, and E/A and E/e′ ratio, compared to patients without DD (n = 63) (all p < 0.05). CMR-derived E and e′ velocities and E/e′ ratio were independent predictors of RV DD. E/e′ of 5.8 demonstrated the highest discrimination of RV DD (AUC 0.76, sensitivity 70

Objectives: To evaluate the feasibility of imaging coronary arteries in neonates with congenital heart disease (CHD) using sub-mSv prospective electrocardiogram (ECG)-triggered coronary CT. Materials & Methods: We retrospectively reviewed neonatal coronary CT images performed on a 16cm-wide detector CT system at a single center from March 2021 to March 2022. Low-dose prospective ECG-triggering coronary CT was performed, and images were reconstructed using an adaptive statistical iterative reconstruction algorithm. Subjective image quality was assessed using a five-point grading scale. Objective image quality was assessed using the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of the aortic root and beam hardening artifacts. Images were compared among neonates of different groups according to weight, birth history, pulmonary infection, and tracheal intubation. Results: Sixty-one participants were included. The incidence of coronary artery anomalies in neonates was 4.92% (3/61). The effective dose was 0.42±0.06mSv, and most images were acceptable for diagnosis, with good agreement between reviewers (κ=0.55–0.67). The visualization rate for the proximal vessel segments and all vessel segments was 90.98% and 81.79%, respectively. Aortic root SNR, CNR were adequately high at 17.33±5.32HU and 22.41±4.31 HU, respectively, and beam hardening artifacts were low at 26.22±11.24 HU. No significant difference in the image quality of the coronary arteries was found between patients of different groups (P>0.05). Conclusion: Sub-millisievert prospective ECG-triggered coronary CT provides excellent coronary visualization in neonates with CHD and may confirm the diagnosis of coronary anomalies. Image quality was not affected by weight, birth history, pulmonary infection, or intubation. Clinical Relevance Statement: sub-millisievert electrocardiograph-triggered cardiac CT provides excellent coronary visualization in neonates with CHD and confirm the diagnosis of coronary anomalies.