The utility of magnetic resonance angiography in children with nutcracker syndrome

Abstract

Background/aim: The presented study aimed to evaluate the utility of magnetic resonance angiography(MRA) in the pediatric population with nutcracker syndrome. Materials and methods:Patients with suggestive clinical symptoms and laboratory findings and got the diagnosis of nutcracker syndrome with Doppler ultrasonography between January 2011-2019 were included in the study. In addition, children who had renal MRA due to hypertension were evaluated as the control group. MRA images of all patients were examined retrospectively by three radiologists at different levels of experience, and the superior mesenteric artery angle, aorta-mesenteric distance, left renal vein diameter both in the regions of aorta-mesenteric and renal hilum were recorded.Results: Forty-five patients diagnosed with nutcracker syndrome were included in the study. The mean age of patients was 12 (4-16) and 30 (67%) were female. As the control group, 25 patients with hypertension who had MRA were included and they had a mean age of 12 (1-18) and 19 (76%) were male. The mean superior mesenteric artery angle was 26.5 ° (16-73 ± 12) in the patient group and 57.8 ° (25-139, ± 33) in the control group (p <0.001); the mean aorta-mesenteric distance was 3.3 mm (1.7-6.5, ± 1.1) in the patient group and 8 mm (3.4-32, ± 5.9) in the control group (p <0.001). MRA measurements of three radiologists were consistent with each other. Conclusion:MRA imaging can be applied as an alternative diagnostic method for Doppler ultrasonography and Multidetector CT examinations by radiologists with different experience levels in pediatric patients with nutcracker syndrome.

Diagnostic Clues in Pediatric Nutcracker Syndrome: From Two Clinical Cases to Current Literature Analysis

“…In this framework, extensive diagnostic procedures are required to confirm the diagnosis and the initial noninvasive work-up includes a Doppler ultrasound, computed tomography (CT) (with both arterial and portal venous phase), or a magnetic resonance imaging (MRI) using angiography sequences [ 26 , 27 , 28 ]. The main non-invasive findings are reported in Table 1 .…”