Leonardi Benedetta, Secinaro Aurelio, Cutrera Renato, Albanese Sonia, Trozzi Marilena, Franceschini Alessio, Silvestri Valentina, Tomà Paolo, Carotti Adriano, Pongiglione Giacomo
Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
Department of Radiology, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
Pediatr Pulmonol. 2015 Aug;50(8):781-8. doi: 10.1002/ppul.23075. Epub 2014 Jun 30.
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.
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.
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.
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.
我们的目的是比较新型非侵入性成像模式在评估血管环（VR）和肺动脉吊带（PAS）中的应用，并了解支气管镜检查在与它们比较评估气管支气管树时的作用。
我们回顾性分析了2008年至2012年间在罗马的 Bambino Gesù 儿童医院诊断为 VR 或 PAS 的41例患者的数据。记录了年龄、性别、临床表现、临床病史、合并症、用于诊断的成像模式（心脏磁共振成像[CMR]、计算机断层扫描[CT]、气管支气管镜检查[TB]）和手术治疗情况。
无论通过 CMR 还是 CT 评估，所有患者的血管解剖结构均被完全明确，基于手术观察诊断准确率为100%。所有 CT 检查均在未使用镇静剂的情况下进行，平均剂量长度乘积（DLP32）为29±9，有效剂量为1.56±0.6 mSv，范围为0.5 - 2.5 mSv。CMR 在所有患者中均需要全身麻醉，但不涉及电离辐射暴露。与 TB 相比，CT 在评估气管狭窄方面比 CMR 表现更好。它在2/3的 PAS 患者中检测到完整的气管软骨环，此外在54%的患者中检测到气管软化和/或支气管软化。
两种横断面成像模式（CT 和 CMR）都能可靠且准确地诊断这些先天性血管异常。虽然 CT 涉及电离辐射暴露，但它避免了与 CMR 所需麻醉相关的风险，并能更准确地评估气管支气管解剖结构。TB 仍然是 VR 有症状患者和 PAS 气管软化诊断的基本工具。
