1
|
Liszewski MC, Ciet P, Winant AJ, Lee EY. Magnetic Resonance Imaging of Pediatric Lungs and Airways: New Paradigm for Practical Daily Clinical Use. J Thorac Imaging 2024; 39:57-66. [PMID: 37015830 DOI: 10.1097/rti.0000000000000707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Disorders of the lungs and airways are among the most common indications for diagnostic imaging in infants and children. Traditionally, chest radiograph has been the first-line imaging test for detecting these disorders and when cross-sectional imaging is necessary, computed tomography (CT) has typically been the next step. However, due to concerns about the potentially harmful effects of ionizing radiation, pediatric imaging in general has begun to shift away from CT toward magnetic resonance imaging (MRI) as a preferred modality. Several unique technical challenges of chest MRI, including motion artifact from respiratory and cardiac motion as well as low signal-to-noise ratios secondary to relatively low proton density in the lung have slowed this shift in thoracic imaging. However, technical advances in MRI in recent years, including developments in non-Cartesian MRI data sampling methods such as radial, spiral, and PROPELLER imaging and the development of ultrashort TE and zero TE sequences that render CT-like high-quality imaging with minimal motion artifact have allowed for a shift to MRI for evaluation of lung and large airways in centers with specialized expertise. This article presents a practical approach for radiologists in current practice to begin to consider MRI for evaluation of the pediatric lung and large airways and begin to implement it in their practices. The current role for MRI in the evaluation of disorders of the pediatric lung and large airways is reviewed, and example cases are presented. Challenges for MRI of the lung and large airways in children are discussed, practical tips for patient preparation including sedation are described, and imaging techniques suitable for current clinical practice are presented.
Collapse
Affiliation(s)
- Mark C Liszewski
- Departments of Radiology and Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Pierluigi Ciet
- Departments of Radiology and Nuclear Medicine
- Pediatric Respiratory Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Kelly D, Juvet F, Lamb V, Holdsworth A. Bronchial collapse and bronchial stenting in 9 dogs. J Vet Intern Med 2023; 37:2460-2467. [PMID: 37695258 PMCID: PMC10658526 DOI: 10.1111/jvim.16859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Principal and lobar bronchial collapse is increasingly recognized as an isolated entity. OBJECTIVE Retrospectively describe the procedure and outcomes of dogs undergoing bronchial stenting at a single referral hospital. ANIMALS Nine client-owned dogs with variable degrees of collapse of the left principal bronchus (LPB), lobar bronchus 1 (LB1), and lobar bronchus 2 (LB2), and with clinically relevant signs of respiratory dysfunction. METHODS Data were collected from patient records. All dogs underwent stenting of the LPB and LB2. Anatomic and functional impairment grades were assigned to each case before and 4 weeks after stenting. Data regarding response to stenting and complications were evaluated. RESULTS Bronchial stenting was considered successful in all cases, with all dogs experiencing improved quality of life (QOL), and decreased functional impairment grade at 4 weeks post-stenting. Follow-up of >6 months was available for 6 dogs and of these, 5 were alive at 12 months, 3 were alive at 18 months, and 1 was alive at 24 months. Stent-related complications occurred in 4 dogs, and were resolvable in 3. Two dogs developed pneumothorax, 1 developed recurrent pneumonia, and 1 developed new-onset coughing. All dogs had mild and manageable coughing post-stenting. CONCLUSIONS AND CLINICAL IMPORTANCE Stenting of the LBP and LB2 might be an effective option for dogs with advanced collapse of these bronchi and associated signs. Although all included dogs had resolution or improvement of clinical signs considered life-threatening or as affecting QOL, ongoing coughing is expected. Patient selection appears important with regard to achieving successful outcomes.
Collapse
Affiliation(s)
- Darren Kelly
- Southern Counties Veterinary SpecialistsRingwoodUnited Kingdom
| | - Florence Juvet
- Southern Counties Veterinary SpecialistsRingwoodUnited Kingdom
| | - Valerie Lamb
- Southern Counties Veterinary SpecialistsRingwoodUnited Kingdom
| | | |
Collapse
|
3
|
Ventilator-Assisted Inspiratory and Expiratory Breath-Hold Thoracic Computed Tomographic Scans Can Detect Dynamic and Static Airway Collapse in Dogs with Limited Agreement with Tracheobronchoscopy. Animals (Basel) 2022; 12:ani12223091. [PMID: 36428319 PMCID: PMC9686793 DOI: 10.3390/ani12223091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
Airway collapse (AC) in dogs includes a tracheal collapse, mainstem and lobar bronchial collapse, and bronchomalacia (i.e., segmental/subsegmental bronchial collapse). The clinical presentation of AC may overlap with non-collapsible airway disease (NCAD) or another non-lower airway respiratory disease (NLARD). This study determined whether paired inspiratory (I)/expiratory (E)-breath-hold computed tomography (I/E-BH CT) can detect a static and dynamic AC in dogs with spontaneous respiratory disease and it compared the CT-derived metrics of the AC to the tracheobronchoscopy metrics. The CT-acquired I and E diameter and cross-sectional area (CSA) for the trachea, mainstem and lobar bronchi in dogs with an AC (n = 16), NCAD (16), and NLARD (19) served for a dynamic percent of the airway narrowing (%AN) calculation. A scoring system assessed the bronchomalacia. The circularity was calculated for each airway. The results were compared to the tracheobronchoscopy collapse grading. In the dogs with an AC, the %AN was larger for the trachea, right mainstem bronchus and right middle lobar bronchus when they were compared to the dogs with NCAD and NLARD. Flattening was only identified for the trachea of the AC dogs. The agreement between the CT and tracheobronchoscopy scores was 20% from trachea to the lobar bronchi and 47% for the segmental/subsegmental bronchi. Paired I/E-BH CT can detect static and dynamic AC with limited agreement with the tracheobronchoscopy metrics. Independent scoring systems that are tailored to the clinical manifestations of functional impairments are needed.
Collapse
|
4
|
Lung and large airway imaging: magnetic resonance imaging versus computed tomography. Pediatr Radiol 2022; 52:1814-1825. [PMID: 35570212 DOI: 10.1007/s00247-022-05386-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 12/29/2022]
Abstract
Disorders of the respiratory system are common in children and imaging plays an important role for initial diagnosis and follow-up evaluation. Radiographs are typically the first-line imaging test for respiratory symptoms in children and, when advanced imaging is required, CT has been the most frequently used imaging modality. However, because of increasing concern about potentially harmful effects of ionizing radiation on children, there has been a shift toward MRI in pediatric imaging. Although MRI of chest in children presents many technical challenges, recent advances in MRI technology are overcoming many of these issues, and MRI is now being used for evaluating the lung and large airway in children at centers with expertise in pediatric chest MRI. In this article we review the state of pediatric lung and large airway imaging, with an emphasis on cross-sectional modalities and the roles of MRI versus CT.
Collapse
|
5
|
Aslam A, De Luis Cardenas J, Morrison RJ, Lagisetty KH, Litmanovich D, Sella EC, Lee E, Agarwal PP. Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Current Concepts and Future Directions. Radiographics 2022; 42:1012-1027. [PMID: 35522576 DOI: 10.1148/rg.210155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are airway abnormalities that share a common feature of expiratory narrowing but are distinct pathophysiologic entities. Both entities are collectively referred to as expiratory central airway collapse (ECAC). The malacia or weakness of cartilage that supports the tracheobronchial tree may occur only in the trachea (ie, tracheomalacia), in both the trachea and bronchi (TBM), or only in the bronchi (bronchomalacia). On the other hand, EDAC refers to excessive anterior bowing of the posterior membrane into the airway lumen with intact cartilage. Clinical diagnosis is often confounded by comorbidities including asthma, chronic obstructive pulmonary disease, obesity, hypoventilation syndrome, and gastroesophageal reflux disease. Additional challenges include the underrecognition of ECAC at imaging; the interchangeable use of the terms TBM and EDAC in the literature, which leads to confusion; and the lack of clear guidelines for diagnosis and treatment. The use of CT is growing for evaluation of the morphology of the airway, tracheobronchial collapsibility, and extrinsic disease processes that can narrow the trachea. MRI is an alternative tool, although it is not as widely available and is not used as frequently for this indication as is CT. Together, these tools not only enable diagnosis, but also provide a road map to clinicians and surgeons for planning treatment. In addition, CT datasets can be used for 3D printing of personalized medical devices such as stents and splints. An invited commentary by Brixey is available online. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Anum Aslam
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Jose De Luis Cardenas
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Robert J Morrison
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Kiran H Lagisetty
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Diana Litmanovich
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Edith Carolina Sella
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Elizabeth Lee
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Prachi P Agarwal
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| |
Collapse
|
6
|
Mitropoulos A, Song WJ, Almaghlouth F, Kemp S, Polkey M, Hull JH. Detection and diagnosis of large airway collapse: a systematic review. ERJ Open Res 2021; 7:00055-2021. [PMID: 34381840 PMCID: PMC8350125 DOI: 10.1183/23120541.00055-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022] Open
Abstract
Large airway collapse (LAC) is a frequently encountered clinical problem, caused by tracheobronchomalacia +/− excessive dynamic airway collapse, yet there are currently no universally accepted diagnostic criteria. We systematically reviewed studies reporting a diagnostic approach to LAC in healthy adults and patients, to compare diagnostic modalities and criteria used. Electronic databases were searched for relevant studies between 1989 and 2019. Studies that reported a diagnostic approach using computed tomography (CT), magnetic resonance imaging or flexible fibreoptic bronchoscopy were included. Random effects meta-analyses were performed to estimate the prevalence of LAC in healthy subjects and in patients with chronic obstructive airway diseases. We included 41 studies, describing 10 071 subjects (47% female) with a mean±sd age of 59±9 years. Most studies (n=35) reported CT findings, and only three studies reported bronchoscopic findings. The most reported diagnostic criterion was a ≥50% reduction in tracheal or main bronchi calibre at end-expiration on dynamic expiratory CT. Meta-analyses of relevant studies found that 17% (95% CI: 0–61%) of healthy subjects and 27% (95% CI: 11–46%) of patients with chronic airways disease were classified as having LAC, using this threshold. The most reported approach to diagnose LAC utilises CT diagnostics, and at a threshold used by most clinicians (i.e., ≥50%) may classify a considerable proportion of healthy individuals as being abnormal and having LAC in a quarter of patients with chronic airways disease. Future work should focus on establishing more precise diagnostic criteria for LAC, relating this to relevant physiological and disease sequelae. CT is mostly used to diagnose LAC, and at a threshold used by most clinicians (i.e. ≥50%) that would classify a large proportion of healthy individuals as being abnormal and LAC in a quarter of patients with chronic airway diseaseshttps://bit.ly/3izAuSk
Collapse
Affiliation(s)
| | - Woo-Jung Song
- Dept of Allergy and Clinical Immunology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Samuel Kemp
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Michael Polkey
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - James H Hull
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
7
|
Lima E, Genta PR, Athanazio RA, Rodrigues AJ, Nakamura MAM, Rached SZ, Costa ELV, Stelmach R. What is the optimal large airway size reduction value to determine malacia: exploratory bronchoscopic analysis in patients in Mounier-Kuhn syndrome. J Thorac Dis 2021; 13:425-429. [PMID: 33569226 PMCID: PMC7867837 DOI: 10.21037/jtd-20-2395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Evelise Lima
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Rodrigues Genta
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Abensur Athanazio
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ascedio José Rodrigues
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Aparecida Miyuki Nakamura
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Samia Zahi Rached
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Leite Vieira Costa
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Diaz Milian R, Foley E, Bauer M, Martinez-Velez A, Castresana MR. Expiratory Central Airway Collapse in Adults: Anesthetic Implications (Part 1). J Cardiothorac Vasc Anesth 2019; 33:2546-2554. [DOI: 10.1053/j.jvca.2018.08.205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 12/17/2022]
|
9
|
May LA, Jadhav SP, Guillerman RP, Ketwaroo PD, Masand P, Carbajal MM, Krishnamurthy R. A novel approach using volumetric dynamic airway computed tomography to determine positive end-expiratory pressure (PEEP) settings to maintain airway patency in ventilated infants with bronchopulmonary dysplasia. Pediatr Radiol 2019; 49:1276-1284. [PMID: 31312862 DOI: 10.1007/s00247-019-04465-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/25/2019] [Accepted: 06/25/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) is a key mechanical ventilator setting in infants with bronchopulmonary dysplasia (BPD). Excessive PEEP can result in insufficient carbon dioxide elimination and lung damage, while insufficient PEEP can result in impaired gas exchange secondary to airway and alveolar collapse. Determining PEEP settings based on clinical parameters alone is challenging and variable. OBJECTIVE The purpose of this study was to describe our experience using dynamic airway CT to determine the lowest PEEP setting sufficient to maintain expiratory central airway patency of at least 50% of the inspiratory cross-sectional area in children with BPD requiring long-term ventilator support. MATERIALS AND METHODS We retrospectively identified all infants with BPD who underwent volumetric CT with a dynamic airway protocol for PEEP optimization from December 2014 through April 2019. Sixteen infants with BPD underwent 17 CT exams. Each CT exam consisted of acquisitions spanning the trachea and mainstem bronchi. We measured cross-sectional area of the trachea and mainstem bronchi and qualitatively assessed the amount of atelectasis. We documented changes in management as a result of the CT exam. RESULTS The average effective dose was 0.1-0.8 mSv/scan. Of 17 CT exams, PEEP was increased in 9, decreased in 3 and unchanged after 5 exams. CONCLUSION Dynamic airway CT shows promise to assist the clinician in determining PEEP settings to maintain airway patency in infants with BPD requiring long-term ventilator support. Further evaluation of the impact of this maneuver on gas exchange, cardiac output and other physiological measures is needed.
Collapse
Affiliation(s)
- Lauren A May
- Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA. .,Department of Radiology, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA.
| | - Siddharth P Jadhav
- Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - R Paul Guillerman
- Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Pamela D Ketwaroo
- Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Prakash Masand
- Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Melissa M Carbajal
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
10
|
Ultralow Dose Dynamic Expiratory Computed Tomography for Evaluation of Tracheomalacia. J Comput Assist Tomogr 2019; 43:307-311. [PMID: 30531547 DOI: 10.1097/rct.0000000000000806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the average effective radiation dose and feasibility of ultralow dose dynamic expiratory computed tomography (CT) for evaluation of tracheomalacia (ULD) and to evaluate factors that impact image quality. METHODS This is a retrospective study of 64 consecutive patients from September to October 2016 for the evaluation of tracheomalacia. All studies were performed with routine inspiration chest CT followed by ULD z(kilovoltage peak (kVp) 80, 100, or 120 and fixed milliamperage 10) or typical dose CT (TD) (kVp 100 or 120 with automated milliamperage) dynamic expiration CT. Image quality was considered diagnostic if the trachea area could be accurately measured for tracheomalacia assessment, and diagnostic studies were graded fair, good, or excellent. Scan length, image quality, and effective radiation dose were compared for ULD versus TD and ULD at 100 kVp versus ULD at 80 kVp. For ULD studies, patient factors were compared across image quality. RESULTS The ULD had a mean effective radiation dose of 0.08 mSv, with all studies of diagnostic image quality. The ULD showed 95% reduction in effective radiation dose (P < 0.001), 14% significant reduction in scan length (P = 0.029), and qualitatively decreased image quality compared w2 ith TD (P < 0.001). The ULD at 100 kVp had significantly better image quality compared with ULD at 80 kVp (P = 0.041) with higher effective radiation dose (0.09 vs 0.05 mSv) (P < 0.001). Body mass index significantly impacted image quality for all ULD studies but not for ULD at 80 or 100 kVp. CONCLUSION For evaluation of tracheomalacia, ULD showed low effective radiation dose less than 0.1 mSv and maintained diagnostic image quality.
Collapse
|
11
|
Improving Quality of Dynamic Airway Computed Tomography Using an Expiratory Airflow Indicator Device. J Thorac Imaging 2018; 33:191-196. [PMID: 29470258 DOI: 10.1097/rti.0000000000000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Dynamic computed tomography (CT) of the airways is increasingly used to evaluate patients with suspected expiratory central airway collapse, but current protocols are susceptible to inadequate exhalation caused by variable patient compliance with breathing instructions during the expiratory phase. We developed and tested a low-cost single-use expiratory airflow indicator device that was designed to improve study quality by providing a visual indicator to both patient and operator when adequate expiratory flow was attained. MATERIALS AND METHODS A total of 56 patients undergoing dynamic airway CT were evaluated, 35 of whom were scanned before introduction of the indicator device (control group), with the rest comprising the intervention group. Lung volumes and tracheal cross-sectional areas on inspiratory/expiratory phases were computed using automated lung segmentation and quantitative software analysis. Inadequate exhalation was defined as absolute volume change of <500 mL during the expiratory phase. RESULTS Fewer patients in the intervention group demonstrated inadequate exhalation. The average change in volume was higher in the intervention group (P=0.004), whereas the average minimum tracheal cross-sectional area was lower (P=0.01). CONCLUSIONS The described expiratory airflow indicator device can be used to ensure adequate exhalation during the expiratory phase of dynamic airway CT. A higher frequency of adequate exhalation may improve reliability and sensitivity of dynamic airway CT for diagnosis of expiratory central airway collapse.
Collapse
|
12
|
Landini N, Diciotti S, Lanzetta M, Bigazzi F, Camiciottoli G, Mascalchi M. Glottis Closure Influences Tracheal Size Changes in Inspiratory and Expiratory CT in Patients with COPD. Acad Radiol 2017; 24:901-907. [PMID: 28341409 DOI: 10.1016/j.acra.2017.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES The opened or closed status of the glottis might influence tracheal size changes in inspiratory and expiratory computed tomography (CT) scans. We investigated if the glottis status makes the tracheal collapse differently correlate with lung volume difference between inspiratory and expiratory CT scans. MATERIALS AND METHODS Forty patients with chronic obstructive pulmonary disease whose glottis was included in the acquired scanned volume for lung CT were divided into two groups: 16 patients with the glottis closed in both inspiratory and expiratory CT, and 24 patients with the glottis open in at least one CT acquisition. Lung inspiratory (Vinsp) and expiratory (Vexp) volumes were automatically computed and lung ΔV was calculated using the following formula: (Vinsp - Vexp)/Vinsp × 100. Two radiologists manually measured the anteroposterior diameter and cross-sectional area of the trachea 1 cm above the aortic arch and 1 cm above the carina. Tracheal collapse was then calculated and correlated with lung ΔV. RESULTS In the 40 patients, the correlations between tracheal Δanteroposterior diameter and Δcross-sectional area at each level and lung ΔV ranged between 0.68 and 0.74 (ρ) at Spearman rank correlation test. However, in the closed glottis group, the correlations were higher for all measures at the two levels (ρ range: 0.84-0.90), whereas in the open glottis group, correlations were low and not statistically significant (ρ range: 0.29-0.34) at the upper level, and moderate at the lower level (ρ range: 0.51-0.55). CONCLUSIONS A closed or open glottis influences the tracheal size change in inspiratory and expiratory CT scans. With closed glottis, the tracheal collapse shows a stronger correlation with the lung volume difference between inspiratory and expiratory CT scans.
Collapse
|
13
|
Severe tracheal and bronchial collapse in adults with type II mucopolysaccharidosis. Orphanet J Rare Dis 2016; 11:50. [PMID: 27112191 PMCID: PMC4845328 DOI: 10.1186/s13023-016-0425-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Mucopolysaccharidosis type II (MPSII) patients frequently suffer from dyspnoea caused by restrictive airway disease due to skeletal abnormalities as well as glycosaminoglycans (GAG) accumulation at different levels of the airway, including the trachea. In this study we describe the extent of the tracheal and bronchial narrowing, the changes in airway diameter during respiration and the effects of these obstructions on respiratory function in adult MPSII patients. Methods Five adult MPSII patients (mean age 40 years) were included. Pulmonary function tests and in- and expiratory chest CT scans were obtained. Cross-sectional areas of trachea and main bronchi were measured at end-inspiration and -expiration and percentage collapse was calculated. Results There was diffuse narrowing of the entire intra-thoracic trachea and main bronchi and severe expiratory collapse of the trachea in all patients. At 1 cm above the aortic arch the median % collapse of the trachea was 68 (range 60 to 77 %), at the level of the aortic arch 64 (range 21–93 %), for the main bronchi this was 58 (range 26–66 %) on the left and 44 (range 9–76 %) on the right side. The pulmonary function tests showed that this airway collapse results in obstructive airway disease in all patients, which was severe (forced expiratory volume <50 % of predicted) in four out of five patients. Conclusion In adult MPS II patients, central airways diameters are strikingly reduced and upon expiration there is extensive collapse of the trachea and main bronchi. This central airways obstruction explains the severe respiratory symptoms in MPSII patients. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0425-z) contains supplementary material, which is available to authorized users.
Collapse
|