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Single Center Review of Diagnostic Testing for Vascular Rings: Is Radiation Necessary?

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Sandhya R. Ramlogan, MD1, James C Nielsen1, Puneet Bhatla2, Laurie Panesar, MD3 and Irene D Lytrivi1, (1)Pediatric Cardiology, Mount Sinai School of Medicine, New York, NY, (2)Pediatric cardiology, Mount Sinai Medical Center, NY, NY, (3)Stony Brook Children's Hospital

Purpose: Currently the diagnosis of vascular rings relies on multiple imaging studies. Neither clear guidelines nor strong supporting evidence exist to the safest, most cost effective approach for accurate diagnosis. This is a retrospective review of the diagnostic testing performed prior to the definitive diagnosis of vascular rings. Specifically, we examined the number of radiation versus non-radiation tests and the accuracy of a non-radiation strategy of echocardiography (ECHO) and/or MRI, using operative findings as the reference standard.

Methods: Clinical databases were searched to identify cases of vascular rings from 1993-2011. MRI, chest X-ray, barium swallow, catheterization, ECHO and operative reports were analyzed for each subject.

Results: Sixty one subjects were identified with the referral diagnosis of a possible vascular ring. As the MRI results were concordant with the operative vascular findings in all subjects with an MRI, we considered a vascular ring to truly be present if either the MRI or operative report confirmed a ring. Twenty two of the 61 subjects had confirmed vascular rings. Median age of 15 (0.1-259) months and weight of 9.9 (2.6-76.8) kg. Mean (SD) tests per subject was 2.1 ± 1.0 and 0.63 ± 0.8, total and radiation, respectively. ECHO was performed in 17 and in 15/17 (88%) the diagnosis was concordant with either the MRI or operative report. Four subjects had MRI with 100% concordance with the operative findings. Two catheterization and 2 barium studies agreed with the operative findings, although the barium failed to completely define the vascular anatomy.

Conclusion: In patients with symptoms suspicious for a vascular ring, echocardiography appears to be a sensitive first line study. These data support a non-radiation approach of echocardiography and/or MRI for the diagnosis of vascular rings. Other radiation studies should be reserved for cases were additional data is critical for decision making.