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A. Contrast-enhanced three-dimensional MR angiograms reveal double aortic arch (arrows) that gave rise to stridor in 75-dayold male infant. Coronal oblique maximum-intensity-projection image shows early bifurcation of ascending aorta.
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€ Diagnostic gadolinium-enhanced MR angiography has been successfully used in the past few years for a vast array of medical indications [1]. With the new high-performance gradients that allow the use of an ultrashort TR and TE, three-dimensional (3D) data sets can now be acquired in a single breath-hold. Also, the new schemes for k-space reconstru...
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Peripheral vascular malformations (PVMs) include a wide spectrum of diseases that can produce potentially life- or limb-threatening complications. The International Society for the Study of Vascular Anomalies (ISSVA) Classification System categorized vascular anomalies into two basic types, the vaso proliferative or vascular neoplasms and developme...
Citations
... However, it is limited in its ability to visualize the aortic arch. Contrastenhanced magnetic resonance angiography (CE-MRA) is a fast, non-invasive imaging technique that does not require radiation, making it a safe and useful tool for diagnosis of congenital aortic arch anomalies (1)(2)(3)(4). However, application of CE-MRA in large groups of young children has been limited. ...
The purpose of this study was to evaluate the accuracy of contrast-enhanced magnetic resonance angiography for the diagnosis of congenital obstructive aortic arch anomalies in children and compare it with transthoracic echocardiography and other MR imaging techniques (ECG gated T1-weighted spin-echo imaging and gradient-echo cine imaging).
Contrast-enhanced magnetic resonance angiography, ECG gated T1-weighted spin-echo imaging, and gradient-echo cine imaging were performed for the diagnosis of congenital obstructive aortic arch anomalies in 416 patients from April 1999 to March 2005 (age range, 3 days to 12 years; mean age, 2.4 years) using a GE 1.5T MR scanner. Transthoracic echocardiography was performed in all patients prior to MR examination. Surgery and/or conventional X-ray angiocardiography were done in all patients to determine the final diagnosis.
The population consisted of 416 patients. Congenital obstructive aortic arch anomalies were diagnosed in 213 patients and ruled out in 203 patients by operation and/or conventional X-ray angiocardiography. Among the 213 patients with anomalies, coarctation of aorta was diagnosed in 174, interruption of aortic arch was diagnosed in 35, and persistent fifth aortic arch with fourth aortic arch interruption was diagnosed in 4 patients. Among the 35 patients with interruption of aortic arch, 21 were of type A, and 14 were of type B. The diagnostic sensitivity, specificity and accuracy of contrast-enhanced magnetic resonance angiography for congenital obstructive aortic arch anomalies were 98% (208/213), 99% (201/203) and 98% (409/416), respectively. The diagnostic sensitivity, specificity and accuracy of transthoracic echocardiography were 88% (187/213), 92% (186/203) and 90% (373/416), respectively. The diagnostic sensitivity, specificity and accuracy of other MR imaging techniques (ECG gated T1-weighted spin-echo imaging and gradient-echo cine imaging) were 89% (189/213), 84% (170/203) and 86% (359/416), respectively.
Contrast-enhanced magnetic resonance angiography is a reliable, noninvasive imaging technique for the diagnosis of congenital obstructive aortic arch anomalies in children. Occasionally, even more information can be obtained from this technique than from conventional X-ray angiocardiography. Contrast-enhanced magnetic resonance angiography is superior to transthoracic echocardiography and other MR imaging techniques (ECG gated T1-weighted spin-echo imaging and gradient-echo cine imaging) for diagnosis of congenital obstructive aortic arch anomalies in children.
... Debido al fenómeno en el que se basa la técnica de RM, la presencia de flujo veloz o turbulento va a condicionar una disminución en la intensidad de la señal, mientras que en aquellos casos en los que exista flujo lento o trombosis la intensidad aumentará. Además, mediante la utilización de medio de contraste y secuencias especialmente diseñadas, es posible la realización de estudios angiográficos 15,16 . La limitación más importante de la RM es que requiere de una plena colaboración por parte del paciente, siendo necesario utilizar sedación en pacientes claustrofóbicos y en la población pediátrica. ...
The diagnosis of haemangiomata and cutaneous vascular malformations is based on clinical history and physical exploration. Imaging studies might be necessary to clarify and confirm the diagnosis, and in order to analyse the extent of the lesions by permitting an evaluation of their non-visible component as well as the affection of neighbouring structures. Finally, they also play an important role when it comes to planning and directing treatment, whether surgical or endovascular. The imaging techniques employed for haemangiomas and vascular malformations include: plain films ultrasound (Doppler), computerised tomography (Angio-CT), magnetic resonance (Angio-MR) and the angiographic techniques (arteriography, phlebography).
... La RM proporciona una imagen excelente en términos de diferenciación tisular que la convierte en la mejor exploración radiológica para demostrar las relaciones anatómicas y estudiar los tejidos circundantes en contacto con las malformaciones vasculares, además de ser capaz de aportar datos hemodinámicos. Mediante la utilización de medio de contraste y secuencias especialmente diseñadas, es posible la realización de estudios angiográficos 31,32 . La limitación más importante de la RM es que requiere de una plena colaboración por parte del paciente. ...
Revisión Las lesiones vasculares son un motivo frecuente de con-sulta en la edad pediátrica. Pese a ello, su correcto diagnósti-co y manejo se ve dificultado por la multitud de clasificacio-nes y por la confusión terminológica existente. La clasifica-ción más generalmente aceptada es la propuesta por Mulliken 1 , quien distingue básicamente entre hemangiomas (que constituyen tumores benignos del endotelio vascular o hiperplasias de vasos), y malformaciones vasculares (lesio-nes con un recambio celular endotelial normal, que repre- Resumen Las lesiones vasculares son motivo frecuente de consulta dermatológica. Grandes esfuerzos se han llevado a cabo para lograr una clasificación que facilite llegar al diagnóstico preciso de la patología y un tratamiento más eficiente. Desde la clásica clasificación de Mulliken a la más actualizada versión de Requena y colaboradores, se ha dejado en claro la diferencia entre hemangiomas y malformaciones vasculares, así como reclasificado el extenso y complejo mundo de las malformaciones vasculares. Este artículo pretende hacer una revisión de la manera en que se clasifican y diagnostican las malformaciones vasculares y los tratamientos disponibles para su tratamiento.
Conotruncal defects (CTD) are related to abnormal division or rotation of the primitive truncus during embryologic development. New cytogenetic techniques, such as Fish analysis, make it possible for the prenatal diagnosis of the 22q11.2 microdeletion syndrome, which has a high frequency with the CTDs. While the echocardiography continues to be the first choice of the non-invasive diagnosis methods, the MSCT and cardiac MRI can have a good imaging of the extracardiac thoracic vessels in children with CTDs. Though angiocardiography in invasive, it still plays an important and irreplaceable role in the full view of systemic and pulmonary arterial. This article reviews the progress and the clinical application of those methods in the conotruncal anomalies. There are differences among the result of the technjes above, and the establishment of an identical criterion for the CTDs is the key to improve the accuracy of the diagnosis.
Diagnosis of vascular malformations is essentially clinical, based on the evolution and morphology of lesions. A biopsy is rarely needed to evaluate the nature of the vessels. Imaging examinations are necessary to assess the extension of malformations as well as the osteomuscular and visceral compromise. New techniques such as 3D angio-CT scan and angio-MRI improve the diagnosis of some vascular malformations, especially the large combined ones such as Klippel-Trénaunay syndrome, thus limiting the need for invasive procedures. On the other hand, the advances in laser technology, particularly pulsed dye laser for port-wine stains and Nd:YAG laser for superficial venous malformations constitute new alternatives for the management of these patients. Other emergent treatments include microfoam sclerotherapy for venous and combined, slow-flow malformations, and new embolizing materials associated to surgery for arterio-venous malformations. The second part of this review is focused on the complementary diagnosis (imaging exams, pathology and accessory tests) and multidisciplinary and specific treatment based on the different groups.
To plan an effective management of thoracic vascular malformations, clinicians must have a clear understanding of the anatomy. Although echocardiography and angiography are the leading imaging modalities in patients with congenital cardiovascular anomalies, magnetic resonance (MR) imaging and computed tomography (CT) are valuable noninvasive adjuncts. MR imaging and CT are effective in demonstrating the complex extracardiac morphology and yield helpful information that can change the treatment plan. Although recent reports state the usefulness of multidetector CT (MDCT), in terms of pediatric population, the significance of radiation exposure should be taken into account. Thus, contrast enhanced MR angiography, as a guide in planning surgery, seems to be the best alternative to conventional angiography in the diagnosis of congenital vascular malformations. In this review, the diagnostic features of thoracic vascular malformations in pediatric population are discussed, and, the potential uses of contrast-enhanced MR angiography are emphasized with the retrospective evaluation of imaging findings in 114 examinations.
With the availability of faster and stronger gradients in MR scanner hardware and advances in MR scanner software, contrast-enhanced MR angiography can be successfully performed even in infants and children despite the technical challenges detailed earlier in this discussion. As the speed of rapid MR imaging approaches real time [25-27], the technique of vascular imaging of infants and children by MR will continue to improve. The current challenges of rapid physiologic motions and the inability of a child to hold breath may not be significant issues in the near future.
Noninvasive imaging for children with liver transplantation for possible sites of vascular and biliary complication remains a challenge. The aim of this study was to investigate the feasibility of magnetic resonance (MR) imaging as a comprehensive noninvasive test for the above purpose.
Thirteen children (age, 8-16 years) with biliary atresia and who received liver transplantation underwent a comprehensive MR study including MR cholangiography and gadolinium-enhanced MR angiography. Images were interpreted by 3 radiologists for liver parenchymal abnormalities; definition of hepatic arterial and venous, portal venous, and biliary anatomy; and detection of any complications. Findings were correlated with surgical records. Conventional angiography and percutaneous cholangiography were obtained for correlation in 2 patients. Confidence level scores (1-5) for depiction of anatomy were given for source, multiplanar, and 3-dimensional images.
Hepatic artery anastomosis was visualized in 12 patients (92%) and the intrahepatic arteries were demonstrated in 10 (77%). The portal, hepatic venous, and biliary anastomoses were clearly demonstrated in all patients. Stenosis of hepatic artery anastomosis and multiple biliary strictures were detected in 1 patient each and confirmed by conventional imaging. High confidence scores (higher than 4) were obtained for all kinds of MR images.
Comprehensive MR imaging can be used in long-term follow-up of pediatric liver transplant recipients for depiction of hepatic structures and possible complications.
