Cardiac MRI detects aortic dilation in pediatric Turner's syndrome

HALIFAX, Nova Scotia — The use of cardiac MRI allows detection of cases of aortic dilation in pediatric patients with Turner’s syndrome, cases that were not seen on echocardiography, according to a prospective cohort study presented here.

“The main challenge [in using cardiac MRI] is that it is more expensive than echocardiography,” said Scott Somerville, MD, a fourth-year resident in pediatric endocrinology at the University of Alberta/Stollery Children's Hospital in Edmonton, Alberta. “In addition, only major centers will have [access to] cardiac MRI. In contrast, echocardiography is noninvasive and performed at most centers, and cardiologists are comfortable interpreting it.”

Somerville said guidelines published in The Journal of Clinical Endocrinology & Metabolism in 2007 called for cardiac MRI to improve visualization of the entire cardiac anatomy in patients with Turner’s syndrome, and he and investigators wanted to determine what value the imaging modality offered specifically in the pediatric population of patients with Turner’s syndrome.

Patients presenting for routine follow-up underwent cardiac MRI and echocardiography within a year of each other, and a cardiologist interpreted the images. The age range of children in the study was 8 to 20 years, with most aged 12 to 16 years. Of 19 patients with Turner’s syndrome, 14 (73.7%) had a cardiac lesion detected. There was a discrepancy in nine of the 14 cases between echocardiography and cardiac MRI. Seven of the nine inconsistencies were explained by a new lesion identified on cardiac MRI that was not identified with echocardiography. Investigators observed that the most common lesion seen on cardiac MRI and not with echocardiography was dilation of the aorta, detected in three of the nine patients.

“We concluded that since cardiac MRI does find a number of lesions that were missed on echocardiography, it is an important complementary imaging modality in children with Turner’s syndrome,” Somerville said. “We are not able to say how often [children with Turner’s syndrome] should have cardiac MRI done. Our plan is to [do research and] figure out when [is best] to do cardiac MRI and how many should be done.”

Clinicians do not currently know why some pediatric patients with Turner’s syndrome progress to aortic dissection while others do not, Somerville said. – by Louise Gagnon

Reference:

Somerville S, et al. Oral Abstract 7. Presented at: Canadian Pediatric Endocrine Group Scientific Meeting; Feb. 19-21, 2015; Halifax, Nova Scotia, Canada.

Disclosure: Somerville reports no relevant financial disclosures.