Imaging modalities in children with vascular ring and pulmonary artery sling. Issue 8 (30th June 2014)

• Record Type: Journal Article
• Authors: Leonardi, Benedetta; Secinaro, Aurelio; Cutrera, Renato; Albanese, Sonia; Trozzi, Marilena; Franceschini, Alessio; Silvestri, Valentina; Tomà, Paolo; Carotti, Adriano; Pongiglione, Giacomo
• Is Part Of: Pediatric pulmonology. Volume 50:Issue 8(2015:Aug.)
• Page Start: 781
• Page End: 788
• Publication Date: 2014-06-30
• Subjects: Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.23075
• Languages: English
• ISSNs: 8755-6863

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Summary</title> <sec id="ppul23075-sec-0001" sec-type="section"> <title>Purpose</title> <p>Our aim is to compare new non‐invasive imaging modalities in the evaluation of vascular ring (VR) and pulmonary artery sling (PAS) and to understand the role of bronchoscopy in comparison with them in assessing tracheobronchial tree.</p> </sec> <sec id="ppul23075-sec-0002" sec-type="section"> <title>Methods</title> <p>We have retrospectively analyzed the data from 41 patients with a VR or a PAS diagnosed at Bambino Gesù Children's Hospital of Rome, between 2008 and 2012. Age, gender, presenting symptoms, clinical history, comorbidities, imaging modalities used for diagnosis (cardiac magnetic resonance [CMR], computed tomography [CT], tracheobronchoscopy [TB]) and surgical treatment were recorded.</p> </sec> <sec id="ppul23075-sec-0003" sec-type="section"> <title>Results</title> <p>The vascular anatomy was completely defined in all patients, whether evaluated by CMR or CT, with a diagnostic accuracy of 100% based on surgical observation. All CT exams were performed without sedation with a mean dose‐length product (DLP<sub>32</sub>) of 29 ± 9 and an effective dose of 1.56 ± 0.6 mSv, range 0.5–2.5 mSv. CMR required general anesthesia in all patients but involved no exposure to ionizing radiation. CT performed better than CMR in assessing tracheal stenosis when compared to TB. It detected complete tracheal cartilage rings in 2/3 patients with PAS, besides tracheomalacia and/or bronchomalacia in 54% of patients.</p> </sec> <sec id="ppul23075-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Both cross‐sectional imaging modalities (CT and CMR) can reliably and accurately diagnose these congenital vascular anomalies. While CT involves exposure to ionizing radiation, it avoids the risks related to anesthesia needed for CMR, and provides a more accurate assessment of tracheobronchial anatomy. TB remains a fundamental tool in tracheomalacia diagnosis in VR symptomatic patients and PAS. <bold>Pediatr Pulmonol. 2015; 50:781–788.</bold> © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>