Malik T H, Bruce I A, Kaushik V, Willatt D J, Wright N B, Rothera M P
Department of Otorhinolaryngology, Central Manchester and Manchester Children's University Hospitals NHS Trust, The Royal Manchester Children's Hospital, Pendlebury, Salford M27 1HA, UK.
Arch Dis Child. 2006 Jan;91(1):52-5. doi: 10.1136/adc.2004.070250. Epub 2005 May 4.
To evaluate the role of magnetic resonance imaging (MRI) in the assessment of children with suspected extrinsic tracheobronchial compression due to vascular anomalies.
Retrospective case note review in a tertiary referral centre. Twenty nine children who underwent dynamic laryngotracheobronchoscopy (DLTB) and were found to have a clinical suspicion of extrinsic tracheobronchial compression were evaluated. All subsequently underwent thoracic MRI within 10 days. The findings on endoscopy were compared to those of MRI, and where performed, echocardiography, aortography, and surgery.
There were 17 males and 12 females (mean age 5 months, range 28 weeks gestation to 60 months). The most common presenting features were stridor and cyanotic episodes. MRI showed abnormalities in 21 patients. There were five vascular rings (three double aortic arches and two right aortic arches) and 11 cases of innominate artery compression. Other vascular anomalies noted included aberrant right subclavian artery and aneurysmal left pulmonary artery. Echocardiography was generally found to be unhelpful in the diagnosis of extra-cardiac vascular abnormalities. Angiography was subsequently conducted in eight children; findings agreed with those shown on MRI. Surgery was performed on all five vascular rings, one innominate artery compression, and one aneurysmal left pulmonary artery. Surgical findings were also compatible with the preoperative MRI.
This study shows the successful use of MRI as the initial imaging modality in endoscopically suspected extrinsic vascular compression of the upper airway. It enables accurate delineation of vascular anomalies and, unlike aortography, is non-invasive and does not require the use of contrast media.
评估磁共振成像（MRI）在评估疑似因血管异常导致的儿童气管支气管外部受压中的作用。
在一家三级转诊中心进行回顾性病例记录审查。对29例接受动态喉镜气管支气管镜检查（DLTB）且临床怀疑有气管支气管外部受压的儿童进行了评估。随后所有患儿均在10天内接受了胸部MRI检查。将内镜检查结果与MRI结果进行比较，并与超声心动图、主动脉造影和手术结果（如已进行）进行比较。
男性17例，女性12例（平均年龄5个月，范围从妊娠28周至60个月）。最常见的临床表现为喘鸣和发绀发作。MRI显示21例患者有异常。有5个血管环（3个双主动脉弓和2个右主动脉弓）以及11例无名动脉受压。其他注意到的血管异常包括迷走右锁骨下动脉和左肺动脉瘤。一般发现超声心动图对诊断心脏外血管异常无帮助。随后对8名儿童进行了血管造影；结果与MRI所示一致。对所有5个血管环、1例无名动脉受压和1例左肺动脉瘤进行了手术。手术结果也与术前MRI相符。
本研究表明，MRI成功地用作上气道内镜疑似外部血管受压的初始成像方式。它能够准确描绘血管异常，并且与主动脉造影不同，是非侵入性的，不需要使用造影剂。
