Pediatric Cardiac Imaging with Second- and Third-Generation Dual Source CT Scanners: Radiation Dose, and Diagnostic Accuracy in Comparison with Echocardiography and MRI—A Systematic Review and Meta-Analysis

Objectives: The purpose of this study was to evaluate the diagnostic accuracy, imaging speed, radiation dose, and clinical utility of second- and third-generation dual source computed tomography scanners, in comparison with echocardiography and magnetic resonance imaging in diagnosing congenital heart disease in paediatric patients. Material and methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 1 January 2006 to 30 April 2025. Eligible studies included pediatric populations undergoing cardiac imaging with modern computed tomography scanners and compared outcomes against echocardiography or magnetic resonance imaging. Study selection followed PRISMA guidelines. Risk of bias was assessed using QUADAS-2 and ROBINS-I tools. Meta-analysis was performed for sensitivity outcomes, and pooled odds ratios were calculated using fixed-effects models. Results: Twenty-four studies met the inclusion criteria, comprising 3 prospective and 21 retrospective studies involving pediatric patients with congenital heart disease. Diagnostic accuracy of computed tomography ranged from 91% to 100%, with pooled sensitivity significantly favoring computed tomography over echocardiography (OR = 3.87; 95% CI: 2.78-5.38; P < 0.00001). Radiation doses were consistently low, ranging from 0.21 to 0.70 mSv with high-pitch and electrocardiogram-gated protocols. Several studies reported clinical impact, including changes in surgical planning and improved anatomical visualization. Risk of bias was moderate in most studies, primarily due to confounding and retrospective designs. Conclusions: Cardiac computed tomography demonstrates high diagnostic accuracy and provides detailed anatomical visualization in pediatric patients with congenital heart disease. It is particularly valuable for assessing extracardiac structures and complex vascular anatomy, where it may complement echocardiography and cardiac magnetic resonance imaging. While radiation exposure has been substantially reduced with newer-generation technologies, the interpretation of findings should consider the methodological limitations of included studies. Further prospective research is needed to strengthen the evidence base. PROSPERO registration: CRD420251042099.