Diagnosis of vascular rings and slings using an interleaved 3D double-slab FISP MR angiography technique.
BACKGROUND
Congenital upper airway obstruction and dysphagia may be caused by vascular rings and slings. Often, invasive and radiation-dependent diagnostic procedures are needed to clarify the diagnosis.


OBJECTIVE
To evaluate the diagnostic utility of high-resolution, free-breathing three-dimensional double-slab fast imaging with steady precession magnetic resonance angiography (3D FISP MRA) in infants and children with respiratory upper airway obstruction and/or dysphagia for detection or exclusion of vascular rings and slings.


METHODS
Eleven patients (median age 1.3 years; range 5.1 months to 15.8 years) were investigated prospectively with 3D FISP MRA and spin-echo techniques. Additional diagnostic data were available from surgery (n=7), cardiac catheterization (n=5), CT (n=2), barium swallow (n=3) and bronchoscopy/oesophagoscopy (n=4).


RESULTS
In one case, diagnosis was missed with low-resolution spin-echo sequences, but high-resolution 3D FISP MRA revealed a double aortic arch. 3D FISP MRA accurately found (n=8) or excluded (n=3) vascular rings or slings in all patients. Using a five-level grading system for 3D FISP MRA image quality (1=non-diagnostic; 5=excellent), the mean grade was 4.3+/-0.7 with no significant grade difference between two independent observers (P=0.81).


CONCLUSIONS
High-resolution 3D FISP MRA accurately defined or excluded vascular rings and slings in patients with respiratory symptoms and/or dysphagia. This technique may provide a non-invasive, radiation-free alternative without contrast agents for diagnosis of vascular rings and slings in free-breathing infants and children.
Greil
Gerald F
GF
Department of Paediatric Cardiology, Children's Hospital, University of Tuebingen, Hoppe Seyler Strasse 3, 72076 Tuebingen, Germany. gerald.greil@med.uni-tuebingen.de
Kramer
Ulrich
U
Dammann
Florian
F
Schick
Fritz
F
Miller
Stephan
S
Claussen
Claus D
CD
Sieverding
Ludger
L
D000293:Adolescent; D000402:Airway Obstruction / Q000000981:diagnostic imaging; D001011:Aorta / Q000002:abnormalities*; D001027:Aortography; D001466:Barium Sulfate; D016122:Brachiocephalic Trunk / Q000002:abnormalities / Q000000981:diagnostic imaging; D001999:Bronchoscopy; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003680:Deglutition Disorders / Q000000981:diagnostic imaging; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007223:Infant; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D013348:Subclavian Artery / Q000002:abnormalities / Q000000981:diagnostic imaging
D003287:Contrast Media; D001466:Barium Sulfate