Imaging Diagnosis Of Children And Fetal Vascular Ring

ObjectiveFor this study using multiple row spiral computer tomography(multislice computed tomography, MSCT) enhancement scan and prenatal MRI(magnetic resonance imaging, MRI) quick scan sequence method, discusses the value of MSCT in diagnosis of various children’s vascular rings and analyses its relationship with the airway malformation, and discusses the value of prenatal MRI in diagnosis of fetus vascular ring malformation.Materials and methods1. The first part. Collected from August 2011 to August 2013 more than 4000 cases of heart surgery, selected 159 cases of vascular ring malformation, including the right aortic arch with aberrant left subclavian artery, pulmonary artery sling, double aortic arch, left right aortic arch and right descending aorta. All cases had MSCT heart enhanced scaning, childrens were in quiet breathing condition, children can’t cooperate we would given oral 10% chloral hydrate sedation(0.4-0.6 ml/kg) before scaning. Scan range from subglottic to telophragma level, foot head or head foot scanning direction, supine position. Scan images using multiplanar reconstruction(MPR), maximum density projection(MIP) analysis of vascular ring type, simultaneously the minimum density projection(Min IP) to observe the relationship between vascular ring and airway. Part of the role of fibre bronchoscopy, fiber bronchoscope trachea form main observation, document inspection report results, convenient contrast with CT results; All children’s surgical methods and operation records were record.2. The second part, collected from March 2013 to August 2014, prenatal women MR images of 320 cases were examed in our hospital, which 8 cases were selected to observe the fetal heart and great vessels. Informed consent were signed by pregnant women before examine, pregnant women didn’t need to sedation or enhanced, adopt the method of foot advanced, supine or lateral position. we used fast scanning sequence, including BFFE(Balanced fast field echo) and SSh- TSE(Single-Shot Turbo-spin-echo) sequenc, with BFFE scanning sequence were given to observe the heart and great vessels form and position, and also need to observe locations of the liver, stomach cavity, the relationships of abdominal great vessels, the run of left and right main bronchial, and the change of double lung signal.ResultsThe first part:159 cases of CT enhanced scan images data, after two high experence radiologist observing, the most common vascular ring was right aortic arch with aberrant left subclavian artery malformation, accounting for 38.9%(62/159), the cause of main airway stenosis was given priority to incidence was 51.6%(32/62); Pulmonary artery sling, 46 cases accounted for 28.9%(46/159), was also a major cause of main airway stenosis, accounted for 60.8%(28/46), pulmonary artery sling was also the most likely to cause tracheal vascular ring malformation the bridge type, the incidence of trachea bridge about 33.3%(14/42); Double aortic arch in 35 cases, the incidence of airway stenosis were the highest, accounted for 74.2%(26/35), of which the main airway stenosis accounted for 96.1%(25/26); Left a right aortic arch and right descending aorta in 16 cases, causing airway stenosis in 10 cases, and only just left main bronchial stenosis. Combined with surgery can see, only 1 case right bow with aberrant left subclavian artery misdiagnosed as double aortic arch and left aortic arch atresia, MSCT diagnostic accuracy was 99.4%. 159 cases of vascular rings had airway stenosis in 101 cases, which 79 were the main airway stenosis, left main bronchial stenosis in 14 cases, 8 cases of right main bronchial stenosis;14 cases of tracheal bridge; Tracheal bronchus in 11 cases; Symmetry bronchus in 2 cases.The second part: All pregnant women prenatal ultrasound reports had been told: 7 cases were suspected right aortic arch, and among 5 cases with aberrant left subclavian artery malformation, 1 case were suspected of left atrial isomerism, after fetal MR examined and observed by two experienced radiologists, we diagnosised vascular rings malformation in 8 cases, including 7 cases of right aortic arch with aberrant left subclavian artery malformation, consistented with the prenatal ultrasound diagnosis in 5 cases, the prenatal US couldn’t find the aberrant left subclavian artery in 2 cases; And other one case, MRI had found one case which merged with right cervical aortic arch; one case of prenatal ultrasound detected ventricular septal defect(size 3 mm), MRI did not showed; one case of left atrial isomerism had been diagnosised by US, combined with aberrant right subclavian artery malformation were not detected, had beed correct diagnosised as the left arch combined aberrant right subclavian artery, left artery catheter by MRI. All 8 cases of fetal 7 cases confirmed after birth, one case of autopsy confirmed, one case of induced labor not confirmed. 7 cases of right aortic arch with aberrant left subclavian artery malformation, only 1 case of merger ventricular septal defect. Left atrial isomerism of symmetry under the left main bronchial artery, inferior vena cava was via singular venous return to the right side of the superior vena cava, the stomach was in the abdominal cavity of right, the liver was in horizontal, spleen could not seen.Conclusion1. The vascular ring malformation could exist at the same time with other congenital heart disease, and the incidence of airway anomalies was very high, often caused compression of airway narrows and malformations, MSCT could clearly display vascular ring, and the diagnosis of vascular ring malformation had very high value. Loop combination of airway pressure and deformity by Min IP intuitive display, MSCT could clearly show the relationship between vascular ring and airway, provided effective help for preoperative assessment and postoperative reasonable treatment.2. Fetal vascular ring can be clearly observed and correctly diagnosised by prenatal MRI fast sequences. MRI in observed heart structure may not be professional to fetal US heart doctor, but observation of peripheral vascular were better than prenatal ultrasound. Fetuses were diagnosised as right aortic arch with aberrant left subclavian artery which were not often accompanied by the complex heart malformation and postnatal growth were well. Fetal cardiac MRI had the characteristics of large view, high resolution, had made it an effective supplementary examinations to ultrasonic.