Cine magnetic resonance imaging for evaluation of focal tracheomalacia: innominate artery compression syndrome.
BACKGROUND
The contribution of an 'aberrant innominate artery' to respiratory distress syndromes has been a matter of debate nearly since the introduction of this concept. Recent advances in dynamic imaging are proving to be of value in assessing tracheal function in patients with respiratory distress. We therefore evaluated patients with innominate artery compression syndrome using the cine magnetic resonance imaging (CMRI) modality.


OBJECTIVE
To apply the CMRI modality to evaluate patients with respiratory distress who exhibited tracheal compression at the level of the innominate artery.


METHODS
A cohort of three patients in respiratory distress underwent bronchoscopy, followed by CMRI using a Siemens 1.5T Vision system.


RESULTS
These three patients exhibited tracheal compression at the level of the innominate artery in agreement with their findings during bronchoscopy. All three exhibited dynamic tracheal compression that varied with the respiratory cycle. The degree of tracheal compromise was readily appreciated using the dynamic, real-time CMRI modality. Due to the severity of symptoms, the two children underwent innominate arteriopexy with complete resolution of their symptoms.


CONCLUSIONS
CMRI provides extremely rapid acquisition of images, as well as integrated information regarding relationships of mediastinal structures. By providing functional imaging of tracheal patency during the respiratory cycle, CMRI may provide additional insight into innominate artery compression syndrome as more patients are evaluated.
Department of Otolaryngology-Head and Neck Surgery and Pediatrics, Children's Hospital of Michigan, Carls Chair of Otolaryngology, Children's Research Center of Michigan, 3901 Beaubien Street, Detroit 48201, USA. rfaust@dmc.org
Russell A
RA
Faust
Frank L
FL
Rimell
Kent B
KB
Remley
D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis; D016122:Brachiocephalic Trunk / Q000002:abnormalities* / Q000601:surgery; D001999:Bronchoscopy; D019299:Decompression, Surgical / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000175:diagnosis*; D016896:Treatment Outcome