title: Pediatric patients with Marfan syndrome: frequency of dural ectasia and its correlation with common cardiovascular manifestations.
abstract: OBJECTIVE
  Marfan syndrome (MFS) is a genetic disorder of the connective tissue. Aortic root dilation is a main criterion of the Ghent Nosology. Dural ectasia and the presence of mitral valve prolapse (MVP) contribute to its systemic score. The purpose of this study was to investigate the frequency of dural ectasia and its correlation with cardiovascular manifestations in a pediatric study population.
  
  
  METHODS
  119 pediatric patients with confirmed or suspected MFS were examined in the local Marfan Clinic. 31 children with MFS who underwent magnetic resonance imaging (MRI) were included. Each patient was evaluated according to the Ghent nosology. Echocardiography was used to measure the aortic root diameter and assess the presence of MVP and mitral regurgitation. Z-scores were calculated for the evaluation of the aortic root diameters. MRI was performed to determine the dural sac ratio (DSR).
  
  
  RESULTS
  The prevalence of dural ectasia was 90.3 %, of aortic root dilation 32.2 %, of MVP 64.5 % and of mitral regurgitation 51.6 %. DSR at L5 correlated with the intraindividual z-scores (slope, 3.62 ± 1.5 [0.56; 6.68]; r = 0.17; p = 0.02; F = 5.84). Z-scores ≥ 2 were accompanied by dural ectasia in 100 %, MVP in 95 % and mitral regurgitation in 100 % of cases. MVP was accompanied by mitral regurgitation in 70 % of cases.
  
  
  CONCLUSIONS
  As the examined cardiac manifestations show a coincidence with dural ectasia in 95 - 100 % of cases, MRI for diagnostic dural sac imaging should be reserved for MFS suspicions with the absence of those manifestations in order to establish the diagnosis according to the Ghent criteria. Thus, the present study supports the recent downgrading of dural ectasia to a contributor to the systemic score.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Ependorf, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Veldhoen
authors.affiliation: Department of Pediatric Cardiology, University Heart Center Hamburg, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Stark
authors.affiliation: Department of Pediatric Cardiology, University Heart Center Hamburg, Germany.
authors.forename: G C
authors.initials: GC
authors.lastname: Mueller
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Ependorf, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Derlin
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Würzburg, Germany.
authors.forename: T A
authors.initials: TA
authors.lastname: Bley
authors.affiliation: Department of Pediatric Cardiology, University Heart Center Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Weil
authors.affiliation: Department of Cardiology, University Heart Center Hamburg, Germany.
authors.forename: Y
authors.initials: Y
authors.lastname: von Kodolitsch
authors.affiliation: Department of Pediatric Cardiology, University Heart Center Hamburg, Germany.
authors.forename: T S
authors.initials: TS
authors.lastname: Mir
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008382:Marfan Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic