Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus / Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection

Introducción: La infección congénita por citomegalovirus (CMV) supone una importante causa de discapacidad. Existen escasas evidencias acerca del valor pronóstico de las lesiones presentes en los estudios de neuroimagen. Objetivo: Analizar la gravedad de las lesiones en la resonancia magnética (RM) y la ecografía transfontanelar, y su relación con déficits neurológicos a largo plazo. Pacientes y métodos: Se realizó un estudio observacional analítico retrospectivo de 36 pacientes con infección congénita por CMV. Se revisaron los estudios de neuroimagen y se clasificaron según la escala de Noyola et al. modificada. Se relacionaron los hallazgos de neuroimagen con la afectación neurológica en su última visita en la consulta de neuropediatría. Resultados: Un total de 36 pacientes fueron estudiados, habiéndose realizado ecografía transfontanelar en 30 y RM cerebral en 29. La ecografía transfontanelar estuvo alterada en 20/30 pacientes, de los cuales, 11 tuvieron alteración en la RM (p = 0,04) y 10 afectación neurológica (p = 0,008). Tuvo una sensibilidad del 83,3%, IC 90%: 58-100 y una especificidad del 44,4%, IC 90%: 18,7-70,2 para la predicción de secuelas neurológicas. La RM estuvo alterada en 20/29 pacientes. Dieciséis de ellos tuvieron afectación neurológica (p < 0,001), teniendo una sensibilidad del 94%, IC 95%: 80-100 y una especificidad del 66,6%, IC 95%: 36-97,5 para la predicción de secuelas neurológicas. Una escala de Noyola et al. ≥ 2 se asoció a retraso psicomotor (p < 0,001). Conclusión: Nuestro trabajo valida los estudios previos en los que se encuentra correlación estadísticamente significativa entre la extensión de las lesiones en neuroimagen y la gravedad de los déficits neurológicos. (AU)

Background: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. Aim: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. Patients and methods: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola’ scale. Imaging findings were compared with neurological alterations in the patients’ most recent follow-up evaluation at the paediatric neurology department. Results: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola’ scale values >2 were correlated with psychomotor retardation (P<.001). Conclusions: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits. (AU)

Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P = .04) and 10 had neurological impairment (P = .008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P < .001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values > 2 were correlated with psychomotor retardation (P < .001). CONCLUSIONS: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.

Evolución y tendencias de un programa de resonancia magnética cardiaca pediátrica en un hospital terciario durante 14 años / Evolution and trends in a pediatric cardiac magnetic resonance imaging program in a tertiary hospital over a 14-year period

OBJETIVOS: 1) Revisar la actividad del programa de resonancia magnética cardiaca (RMC) de nuestro hospital desde su inicio hasta la actualidad; 2) evaluar la evolución del número de pacientes, estudios bajo anestesia, estudios con contraste (angiografía y realce tardío) y patologías representativas, y 3) estimar la tendencia de los mismos parámetros evaluados. MATERIAL Y MÉTODOS: El programa de RMC pediátrica de nuestro hospital comenzó el 14 de febrero de 2005. Revisamos los estudios hasta el 31 de diciembre de 2018. Los casos son incluidos en una tabla de cálculo que incluye sexo, fecha de nacimiento, fecha de exploración, clínica, diagnóstico radiológico, secuencias realizadas y anestesia. Obtenemos datos por años de la edad de los pacientes, la realización de estudios bajo anestesia, realización de angiografía por resonancia magnética con contraste, estudios de realce tardío y estudios posquirúrgicos. También valoramos la evolución de un grupo de patologías representativas: coartación aórtica, tetralogía de Fallot, D-transposición de las grandes arterias, correcciones univentriculares, síndrome del corazón izquierdo hipoplásico, retornos venosos pulmonares anómalos y miocardiopatías. Realizamos gráficos de barras, evolución de las medias y curvas logarítmicas de tendencia. RESULTADOS: El número total de casos fue 2.606. Se registró un incremento gradual del número de casos. La media de edad de los pacientes fue de 12,5 años y también se incrementó a lo largo del periodo; el 42% de los casos se realizaron con anestesia. En el 57,6% de los casos se realizó angio-RM con contraste, y en el 42,13%, estudio de realce tardío. La coartación aórtica ha representado la patología más frecuente (16,39%), aunque su número ha descendido paulatinamente a lo largo del periodo, y también lo ha hecho el corazón izquierdo hipoplásico. La patología del miocardio (7,25% de casos) ha aumentado paulatinamente, hasta representar el 9,35% en 2018. CONCLUSIÓN: A lo largo de estos 14 años, la patología estudiada, el tipo de pacientes y la técnica empleada han ido variando, con un aumento del número de pacientes y de su edad, una disminución de los estudios de angio-RM, y cambios en la prevalencia de los distintos grupos de patologías

OBJECTIVES: 1. To review the activity in our hospital's pediatric cardiac magnetic resonance imaging (cMRI) program from its inception to the present.2. To evaluate changes in the number of patients, in the number of studies done under anesthesia, in the number of studies done with contrast material (magnetic resonance angiography (MRA) and delayed enhancement), and in representative diseases studied.3. To estimate trends in the parameters evaluated in objective 2. MATERIAL AND METHODS: The pediatric cMRI program at our hospital started on February 14, 2005. We assessed cMRI studies done between the inception of the program and December 31, 2018. The cases were entered in a calculation table that included sex, date of birth, date of examination, clinical presentation, radiologic diagnosis, sequences done, and anesthesia. For each year, we obtained data about patients' age, studies done under anesthesia, contrast-enhanced MRA, delayed enhancement studies, and postoperative studies. We also evaluated the evolution of the number of patients studied for a group of representative diseases (coarctation of the aorta; tetralogy of Fallot; dextro-transposition of the great arteries; corrections of univentricular heart; hypoplastic left heart syndrome; anomalous pulmonary venous return; and cardiomyopathy). We analyzed these data with bar graphs, evolutions of means, and logarithmic trend curves. RESULTS: A total of 2606 cases were included. The number of cases per year increased gradually. The mean age of all patients was 12.5 years, and the age of the patients studied also increased during the 14-year period. Anesthesia was used in 42%. Contrast-enhanced MRA was done in 57.6% and delayed enhancement in 42.13%. The most common condition was aortic coarctation (16.39%), although the frequency of aortic coarctation and hypoplastic left heart syndrome decreased slightly during the period. By contrast, the frequency of cardiomyopathy (7.25% of cases) increased slightly, to the point where it represented 9.35% in 2018. CONCLUSION: During the 14-year period in which pediatric cMRI has been done at our hospital, the conditions studied, the type of patients, and the techniques used has varied; the number of patients and patients' age has increased, where as the frequency of MRA studies has decreased. The prevalence of the different conditions studied has also changed

Síndrome de Kearns-Sayre: ausencia de respuesta clínica al tratamiento con ácido folínico oral / Kearns-Sayre syndrome: Absence of clinical response to treatment with oral folinic acid

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Evolution and trends in a pediatric cardiac magnetic resonance imaging program in a tertiary hospital over a 14-year period. / Evolución y tendencias de un programa de resonancia magnética cardiaca pediátrica en un hospital terciario durante 14 años.

OBJECTIVES: 1. To review the activity in our hospital's pediatric cardiac magnetic resonance imaging (cMRI) program from its inception to the present. 2. To evaluate changes in the number of patients, in the number of studies done under anesthesia, in the number of studies done with contrast material (magnetic resonance angiography (MRA) and delayed enhancement), and in representative diseases studied. 3. To estimate trends in the parameters evaluated in objective 2. MATERIAL AND METHODS: The pediatric cMRI program at our hospital started on February 14, 2005. We assessed cMRI studies done between the inception of the program and December 31, 2018. The cases were entered in a calculation table that included sex, date of birth, date of examination, clinical presentation, radiologic diagnosis, sequences done, and anesthesia. For each year, we obtained data about patients' age, studies done under anesthesia, contrast-enhanced MRA, delayed enhancement studies, and postoperative studies. We also evaluated the evolution of the number of patients studied for a group of representative diseases (coarctation of the aorta; tetralogy of Fallot; dextro-transposition of the great arteries; corrections of univentricular heart; hypoplastic left heart syndrome; anomalous pulmonary venous return; and cardiomyopathy). We analyzed these data with bar graphs, evolutions of means, and logarithmic trend curves. RESULTS: A total of 2606 cases were included. The number of cases per year increased gradually. The mean age of all patients was 12.5 years, and the age of the patients studied also increased during the 14-year period. Anesthesia was used in 42%. Contrast-enhanced MRA was done in 57.6% and delayed enhancement in 42.13%. The most common condition was aortic coarctation (16.39%), although the frequency of aortic coarctation and hypoplastic left heart syndrome decreased slightly during the period. By contrast, the frequency of cardiomyopathy (7.25% of cases) increased slightly, to the point where it represented 9.35% in 2018. CONCLUSION: During the 14-year period in which pediatric cMRI has been done at our hospital, the conditions studied, the type of patients, and the techniques used has varied; the number of patients and patients' age has increased, where as the frequency of MRA studies has decreased. The prevalence of the different conditions studied has also changed.

Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection. / Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values >2 were correlated with psychomotor retardation (P<.001). CONCLUSIONS: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.

Síndrome de encefalopatía posterior reversible: a propósito de dos casos / Posterior reversible encephalopathy syndrome: about two cases

El síndrome de encefalopatía posterior reversible es una entidad clinicorradiológica cada vez más conocida en la práctica diaria pediátrica, pero puede presentarse con una sintomatología neurológica muy diversa (cefalea, alteración del nivel de conciencia, pérdida de visión, crisis convulsivas, etc.), generalmente asociada a un cuadro de hipertensión arterial o insuficiencia renal. Para su diagnóstico se utilizan actualmente pruebas de imagen, como la resonancia magnética, con una elevada sensibilidad, la tomografía computarizada y el electroencefalograma. Su manejo radica en el tratamiento de las crisis y el control de la presión arterial, además de la eliminación de los factores predisponentes, y suele tener un buen pronóstico, con una resolución completa del cuadro en días o semanas

Posterior reversible encephalopathy syndrome is a clinical-radiological entity that is increasingly known in pediatric practice but it can be presented with a diverse neurological clinic (headache, altered consciousness level, loss of vision, seizures, etc.), usually associated to an episode of hypertension or renal failure. Imaging tests such as magnetic resonance, with greater sensitivity, and computed tomography or electroencephalogram are currently used for diagnosis. Its management is based in seizures treatment and control of blood pressure in addition to the elimination of predisposing factors and it usually has a good prognosis with a complete resolution of the episode in days or weeks

Valoración radiológica de los tumores congénitos / Radiological evaluation of congenital tumors

Los tumores congénitos son aquellos tumores diagnosticados durante el embarazo y los tres primeros meses de vida. Constituyen un grupo heterogéneo de neoplasias con unas características biológicas y epidemiológicas especiales que los diferencian del resto de los tumores pediátricos y de la edad adulta. Su detección prenatal ha aumentado en las dos últimas décadas debido a la generalización del cribado ecográfico prenatal. El desarrollo de las técnicas de imagen, especialmente la resonancia magnética (RM) fetal, ha permitido mejorar el diagnóstico, el seguimiento y el manejo clínico y terapéutico perinatal de estos tumores. Presentamos una revisión basada en imágenes de los tumores congénitos más frecuentes, describiendo los tipos histológicos, localizaciones y sus características en las distintas técnicas de imagen empleadas (AU)

In this article, we consider tumors that are diagnosed during pregnancy or in the first three months of life. This is a heterogeneous group of neoplasms with special biological and epidemiological characteristics that differentiate them from tumors arising in children or adults. In the last two decades, the prenatal detection of congenital tumors has increased due to the generalized use of prenatal sonographic screening. Advances in imaging techniques, especially in fetal magnetic resonance imaging, have enabled improvements in the diagnosis, follow-up, clinical management, and perinatal treatment of these tumors. This image-based review of the most common congenital tumors describes their histologic types, locations, and characteristics on the different imaging techniques used (AU)

Calidad de la coronariografía 3D por resonancia magnética en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene / Quality of 3D magnetic resonance imaging of coronary arteries in patients with D-transposition of the great arteries after the Jatene switch procedure

Objetivos. Valorar la calidad de imagen de la secuencia 3D de todo el corazón (3D balanced fast field echo, whole heart [WH3D]) para estudiar la anastomosis coronaria y las estenosis coronarias en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene. Material y métodos. Rescatamos de la base de datos de RM cardiaca pediátrica 100 exploraciones en 83 pacientes intervenidos con la técnica de Jatene y secuencia WH3D. Cumplían criterios de inclusión en el estudio 84 exploraciones. Valoramos las estenosis coronarias mediante WH3D y su correlación con la TC coronaria o la angiografía por catéter. Estudiamos retrospectivamente la calidad de la imagen de las arterias coronarias proximales con una escala de 4 puntos y la correlación con la edad, frecuencia cardiaca y tamaño cardiaco. Resultados. Cuatro de los 84 estudios (4,8%) mostraron calidad «insuficiente» para el diagnóstico, 7 (8,3%) «discreta», 23 (27,4%) «buena» y 50 (59,5%) «excelente». La frecuencia cardiaca y la calidad de la imagen coronaria se relacionaron estadísticamente. Con la RM detectamos estenosis en el origen coronario en 9 exploraciones (10,7%). Conclusión. La calidad de imagen con la secuencia WH3D fue diagnóstica en la mayoría de los pacientes intervenidos con la técnica de Jatene, mejor en pacientes con menor frecuencia cardiaca. En el 10,7% se diagnosticó una estenosis del origen coronario que obligó a nuevas exploraciones (AU)

Objectives. To evaluate the quality of images obtained with 3D balanced fast-field echo whole heart (WH3D) MRI sequences for assessing the coronary anastomosis and coronary stenosis in patients with D-transposition of the great arteries who have undergone the Jatene switch procedure. Material and methods. We retrieved 100 WH3D studies done in 83 patients who had undergone the Jatene switch procedure from our pediatric cardiac MRI database; 84 of these studies fulfilled the criteria for inclusion in the study. We evaluated coronary stenoses on WH3D MR images and their correlation with coronary CT or angiography images. We retrospectively studied the quality of the images of the proximal coronary arteries using a four-point scale and correlating the findings with age, heart rate, and heart size. Results. Of the 84 studies, 4 (4.8%) were of a quality considered «insufficient for diagnosis», 7 (8.3%) were considered «fair», 23 (27.4%) «good», and 50 (59.5%) «excellent». The quality of the image of the coronary arteries was significantly correlated with heart rate. MRI detected stenosis in the origin of the coronary arteries in 9 (10.7%) studies. Conclusion. Images obtained with the WH3D MRI sequence in patients who had undergone the Jatene procedure were of diagnostic quality in most cases and were better in patients with lower heart rates. In 10.7%, stenosis in the origin of the coronary arteries that required new studies was detected (AU)

[Radiological evaluation of congenital tumors]. / Radiografía del abdomen en Urgencias. ¿Una exploración para el recuerdo?

In this article, we consider tumors that are diagnosed during pregnancy or in the first three months of life. This is a heterogeneous group of neoplasms with special biological and epidemiological characteristics that differentiate them from tumors arising in children or adults. In the last two decades, the prenatal detection of congenital tumors has increased due to the generalized use of prenatal sonographic screening. Advances in imaging techniques, especially in fetal magnetic resonance imaging, have enabled improvements in the diagnosis, follow-up, clinical management, and perinatal treatment of these tumors. This image-based review of the most common congenital tumors describes their histologic types, locations, and characteristics on the different imaging techniques used.

[Quality of 3D magnetic resonance imaging of coronary arteries in patients with D-transposition of the great arteries after the Jatene switch procedure]. / Calidad de la coronariografía 3D por resonancia magnética en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene.

OBJECTIVES: To evaluate the quality of images obtained with 3D balanced fast-field echo whole heart (WH3D) MRI sequences for assessing the coronary anastomosis and coronary stenosis in patients with D-transposition of the great arteries who have undergone the Jatene switch procedure. MATERIAL AND METHODS: We retrieved 100 WH3D studies done in 83 patients who had undergone the Jatene switch procedure from our pediatric cardiac MRI database; 84 of these studies fulfilled the criteria for inclusion in the study. We evaluated coronary stenoses on WH3D MR images and their correlation with coronary CT or angiography images. We retrospectively studied the quality of the images of the proximal coronary arteries using a four-point scale and correlating the findings with age, heart rate, and heart size. RESULTS: Of the 84 studies, 4 (4.8%) were of a quality considered «insufficient for diagnosis¼, 7 (8.3%) were considered «fair¼, 23 (27.4%) «good¼, and 50 (59.5%) «excellent¼. The quality of the image of the coronary arteries was significantly correlated with heart rate. MRI detected stenosis in the origin of the coronary arteries in 9 (10.7%) studies. CONCLUSION: Images obtained with the WH3D MRI sequence in patients who had undergone the Jatene procedure were of diagnostic quality in most cases and were better in patients with lower heart rates. In 10.7%, stenosis in the origin of the coronary arteries that required new studies was detected.

Diagnóstico prenatal y manejo del quiste broncogénico / Prenatal diagnosis and management of bronchogenic cyst

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Pericarditis recurrente secundaria a un quiste pericárdico / Recurring secondary pericarditis due to pericardial cyst

Los procesos expansivos intratorácicos son infrecuentes en la infancia, y se localizan habitualmente en el mediastino. La escasa expresión clínica inicial condiciona un diagnóstico tardío y dificulta el tratamiento efectivo. Se clasifican según la localización topográfica (anterior, media o posterior), lo que permite establecer una orientación diagnóstica basada en las estructuras de cada compartimento. La patología tumoral es la más frecuente, aunque no hay que descartar la etiología infecciosa o malformativa (quística-vascular) y la patología tiroidea opericárdica, como el caso que motiva esta publicación. La radiografía de tórax es la técnica diagnóstica inicial, aunque generalmente se requiere la realización de una tomografía computarizada (mediastino anterior y medio) o una resonancia magnética (mediastino posterior), que localizan y delimitan la lesión e informan de su consistencia y contenido. La ecografía es coste efectiva, no invasiva, está libre de radiación y permite evaluar el timo o el pericardio. Las masas pericárdicas son infrecuentes, generalmente congénitas, aunque pueden tener un origen inflamatorio; su tratamiento es conservador, y está indicada la cirugía si el tamaño es grande o la sintomatología persistente(AU)

The intrathoracic expansive mass are infrequent during infancy, being the common localization the mediastinic, the scarce clinical expression conditions to a late diagnosis obstructing the effective treatment. They are classified according to topographic localization (front, middle or back) allowing a diagnosis orientation based on the structures of each compartment. The tumoral pathology is the most frequent, not being despised the infectious etiology, malformative (cystic or vascular), the thyroid pathology or pericardial, as the case, which this articleis based on. The thorax x-ray is the initial diagnosis technique, although generally a cat scan is needed of the (front mediastinum or middle) or a magnetic resonance (back mediastinum)that localizes and defines the lesion, informing of the consistency and context. The ecography is cheap not invasive, radiation free and allows evaluating the thymus and pericardium. The pericardial masses are infrequent, generally congenital, although they might have an inflammatory origin; its treatment is conservative, surgery is indicated if the size is big or the group of symptoms is persistent(AU)

Angiografía con contraste por resonancia magnética en las cardiopatías congénitas / Contrast-enhanced magnetic resonance angiography in congenital heart disease

El avance de la resonancia magnética (RM) de cuerpo ha visto en la angiografía con contraste por RM (ACRM) uno de sus mayores logros. La evaluación no invasiva de arterias y venas evita la realización de cateterismo, la administración de contraste yodado y la exposición a radiaciones ionizantes a un gran número de pacientes. Este hecho es, si cabe, de mayor relevancia en los niños con cardiopatías congénitas, al tratarse de pacientes a los que habrá que realizar numerosos estudios vasculares a lo largo de su vida, con los riesgos inherentes del cateterismo, los debidos al contraste yodado, y la mayor susceptibilidad de estos pacientes a los efectos de las radiaciones ionizantes. La ACRM aporta abundante información para el diagnóstico y seguimiento posquirúrgico en este grupo de pacientes que, con los avances terapéuticos médicos y quirúrgicos, hoy en día alcanzan edades avanzadas y reciben, cada vez más, numerosos estudios de imagen a lo largo de su vida. En esta revisión se analiza la técnica de la ACRM en estos pacientes, los problemas y precauciones relativas al uso del gadolinio, las indicaciones y los hallazgos radiológicos a los que hay que prestar especial atención en esta patología (AU)

Contrast-enhanced MR angiography is one of the greatest achievements brought about byadvances in body MRI. The non invasive evaluation of arteries and veins can obviate heartcatheterization, the administration of iodinated contrast, and exposure to ionizingradiation in many patients and spare them the risks associated with these factors. These gains are even more important in children with congenital heart disease, who will have toundergo numerous vascular studies in their life times and are more susceptible to theeffects of ionizing radiation. Contrast-enhanced MR angiography provides abundantinformation for diagnosis and postoperative follow-up in these patients, who reachadvanced age thanks to advances in medical and surgical treatment and thus receive moreand more imaging studies during their life times. In this review, we analyze the contrast-enhanced MR angiography technique in these patients, the problems and precautionsrelated to the use of gadolinium, the indications for the test, and the relevant imagingfindings in patients with congenital heart disease (AU)