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Diagnosis of vascular rings and slings using an interleaved 3D double-slab FISP MR angiography technique

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Abstract

Background: Congenital upper airway obstruction and dysphagia may be caused by vascular rings and slings. Often, invasive and radiation-dependent diagnostic procedures are needed to clarify the diagnosis. Objective: To evaluate the diagnostic utility of high-resolution, free-breathing three-dimensional double-slab fast imaging with steady precession magnetic resonance angiography (3D FISP MRA) in infants and children with respiratory upper airway obstruction and/or dysphagia for detection or exclusion of vascular rings and slings. Materials and methods: Eleven patients (median age 1.3 years; range 5.1 months to 15.8 years) were investigated prospectively with 3D FISP MRA and spin-echo techniques. Additional diagnostic data were available from surgery (n=7), cardiac catheterization (n=5), CT (n=2), barium swallow (n=3) and bronchoscopy/oesophagoscopy (n=4). Results: In one case, diagnosis was missed with low-resolution spin-echo sequences, but high-resolution 3D FISP MRA revealed a double aortic arch. 3D FISP MRA accurately found (n=8) or excluded (n=3) vascular rings or slings in all patients. Using a five-level grading system for 3D FISP MRA image quality (1=non-diagnostic; 5=excellent), the mean grade was 4.3±0.7 with no significant grade difference between two independent observers (P=0.81). Conclusions: High-resolution 3D FISP MRA accurately defined or excluded vascular rings and slings in patients with respiratory symptoms and/or dysphagia. This technique may provide a non-invasive, radiation-free alternative without contrast agents for diagnosis of vascular rings and slings in free-breathing infants and children.

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Acknowledgements

We thank the “EHLKE” foundation and the “Stiftung zur Förderung der Erforschung von Zivilisationserkrankungen, Baden-Baden, Germany” for financial support and Vital Images Corporation, Plymouth, MN, USA, for technical assistance in volume rendering the 3D datasets.

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Authors and Affiliations

  1. Department of Paediatric Cardiology, Children’s Hospital, University of Tuebingen, Hoppe Seyler Strasse 3, 72076, Tuebingen, Germany

    Gerald F. Greil & Ludger Sieverding

  2. Department of Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany

    Ulrich Kramer, Florian Dammann, Fritz Schick, Stephan Miller & Claus D. Claussen

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  1. Gerald F. Greil
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  2. Ulrich Kramer
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  3. Florian Dammann
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  4. Fritz Schick
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  5. Stephan Miller
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  6. Claus D. Claussen
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  7. Ludger Sieverding
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Correspondence to Gerald F. Greil.

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Greil, G.F., Kramer, U., Dammann, F. et al. Diagnosis of vascular rings and slings using an interleaved 3D double-slab FISP MR angiography technique. Pediatr Radiol 35, 396–401 (2005). https://doi.org/10.1007/s00247-004-1376-4

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  • DOI: https://doi.org/10.1007/s00247-004-1376-4

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