Elena Karavaeva MD, Presenter: Nothing to Disclose

M. Ines Boechat MD, Abstract Co-Author: Nothing to Disclose

Simon Gabriel MD, Abstract Co-Author: Nothing to Disclose

J. Paul Finn MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Bracco Group

to assess the feasibility of high resolution, 3D contrast enhanced MR Angiography (CEMRA) as a single test for complete evaluation of detailed vascular and proximal 3-dimensional airway anatomy in pediatric patients with suspected vascular rings.

Forty-two consecutive pediatric patients (25 male, 17 female; mean age, 6.14 +/- 4.07 years, range 1m to 13 y) with a clinical suspicion of vascular rings underwent multiphase, high spatial resolution CEMRA at 3.0T (31 patients) or 1.5T (15 patients) with gadolinium-based contrast medium (Multihance, Bracco Diagnostics, N=38, 0.2 mmol /kg, or Ablavar, Lantheus Medical, N=3, 0.06 mmol /kg). Using a standardized scoring system 2 independent, board certified radiologists scored the studies for image quality, artifacts, the visibility of upper airways that were divided into 5 segments: trachea, right main stem bronchus, left main stem bronchus, right upper lobe bronchus and bronchus intermedius. Additionally, all studies were evaluated for the presence of pathology, including vascular rings and trachea-bronchial compression, by the same two radiologists and a third independent board certified radiologist. Correlation with chest X-ray findings was available in all patients and with chest CT in 12 patients.

All scans were scored as highly diagnostic with good or excellent image quality. Visualization of the trachea and bronchi was assessed as confident and very confident, the interobserver agreement was considered as ‘good’ and ‘excellent’ (Cohen’s kappa ranged from 0.607 to 0.846 depending on scored segment). A total of 10 vascular rings with tracheobronchial compression were detected with excellent interobserver agreement (Fleiss’ kappa = 1). The mean difference between MR and CT measurements of trachea diameter at 3 different levels was 0.45 +/- 0.3 mm.

High resolution CE MRA allowed for confident assessment of both vascular anatomy and relevant 3-dimensional trachea-bronchial anatomy in pediatric patients with suspected vascular rings. The complementary 3-D visualization of vascular and airway anatomy with CEMRA may make supplemental CT imaging unnecessary in appropriate patient groups.

High resolution CEMRA can evaluate 3D vascular anatomy and relevant 3D airway anatomy in children suspected of tracheobronchial compression, obviating the need for CT scanning and radiation exposure

Karavaeva, E, Boechat, M, Gabriel, S, Finn, J, High Resolution, Contrast Enhanced MR Angiography as the Sole Test for Evaluation of Broncho-Vascular Anatomy in Pediatric Patients with Suspected Vascular Rings.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018634.html