title: Imaging modalities in children with vascular ring and pulmonary artery sling.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (DLP32 ) 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Benedetta
authors: B
authors: Leonardi
authors: Department of Radiology, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Aurelio
authors: A
authors: Secinaro
authors: Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Renato
authors: R
authors: Cutrera
authors: Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Sonia
authors: S
authors: Albanese
authors: Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Marilena
authors: M
authors: Trozzi
authors: Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Alessio
authors: http://orcid.org/0000-0003-2339-093X
authors: A
authors: Franceschini
authors: Department of Radiology, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Valentina
authors: V
authors: Silvestri
authors: Department of Radiology, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Paolo
authors: P
authors: Tomà
authors: Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Adriano
authors: A
authors: Carotti
authors: Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
authors: Giacomo
authors: G
authors: Pongiglione
mesh_terms: D001999:Bronchoscopy; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000175:diagnosis*
keywords: cardiac magnetic resonance; computed tomography; congenital thoracic arterial anomalies; tracheobronchoscopy; vascular rings