Purpose or Case Report: Tracheobronchial anomalies including tracheobronchial stenosis, tracheal bronchus, cardiac bronchus and bronchial isomerism are common in congenital heart disease. Cardiovascular anomaly is the principal extrinsic lesion causing tracheobronchial stenosis. MRI has the advantage of being non-ionizing and providing excellent soft tissue contrast for the diagnosis of congenital heart disease and tracheobronchial anomalies
Purpose: To define diagnostic accuracy of three-dimensional turbo field echo (3D-TFE) to detect tracheobronchial anomalies in patients with congenital heart disease
Methods & Materials: Sixty-eight patients with congenital heart disease from December 1, 2013 to September 31, 2014 were retrospectively reviewed. Cardiac MR was performed to provide further preoperative information about anatomy and function. In 68 patients, age ranged from 1.4 months to 134 months; the median age was 10.4 months. A 3D-TFE and 3D Balanced turbo field echo (3D B-TFE) sequences were performed on all patients to evaluate tracheobronchial anatomy. All patients also underwent multi-slice computed tomography (MSCT) either before or after MRI. Inter-modality agreement for tracheobronchial anomaly findings was tested by the kappa coefficient and the sensitivity, specificity of 3D-TFE for the detection of tracheobronchial anomalies were evaluated
Results: Among the 68 cases, 35 cases had a normal tracheobronchial tree, 33 had tracheobronchial anomalies (1 had situs inversus bronchus, 3 had bronchial isomerism, 8 had tracheal bronchus and 25 had tracheobronchial stenosis). The predominant causes of tracheobronchial stenosis were double aortic arch, right aortic arch with mirror-image branching, right aortic arch with left aberrant subclavian artery and posterior patent ductus arteriosus (PDA) or ligament, left pulmonary artery sling enlarged left atrium. There was excellent inter-modality agreement between 3D-TFE and MSCT for the detection of tracheobronchial anomalies. The sensitivity and specificity of 3D-TFE were 90% and 84%.
Conclusions: 3D-TFE is a useful MRI sequence for demonstrating the tracheobronchial tree and diagnosing tracheobronchial anomalies in congenital heart disease. MRI can supply helpful information for preoperative strategies.