Prospective Evaluation of Free-Breathing Fast T2-Weighted MultiVane XD Sequence at 3-T MRI for Large Airway Assessment in Pediatric Patients

Tracheobronchial abnormalities on computed tomography angiography in children with congenital heart disease

OBJECTIVES

To evaluate the assortment of tracheobronchial abnormalities on computed tomography angiography (CTA) in children with congenital heart disease (CHD).

METHODS

In this study approved by the Institute ethics committee, CTA studies of 182 children (age range: 2 days-8 years) with CHD, performed from July 2021 to March 2023 were analyzed. Two pediatric radiologists independently assessed the tracheobronchial airways (from the trachea to lobar bronchi) for developmental and branching anomalies and airway compromise (narrowing). In cases which demonstrated airway compromise, the extent and the cause of airway narrowing were evaluated, and the etiology were divided into extrinsic and intrinsic causes. Interobserver agreement between the two radiologists was calculated using kappa statistics.

RESULTS

One hundred children demonstrated normal airway anatomy and no luminal narrowing. Airway narrowing was observed in 63 (34.6%) children (κ: 0.954), and developmental airway anomalies were seen in 32 (17.5%) children (κ: 0.935). Of the 63 children with airway narrowing, 47 (25.8%) children had extrinsic cause for narrowing, 11 (6%) children had intrinsic causes for narrowing, and 5 (2.7%) children had both intrinsic and extrinsic causes attributing to airway compromise. Significant airway narrowing (>50% reduction) was seen in 35 (19.2%) children (κ: 0.945).

CONCLUSION

Tracheobronchial airway abnormalities are frequently associated in children with CHD and need to be appraised preoperatively. Cross-sectional imaging with CTA provides excellent information on tracheobronchial airway anatomy and caliber as well as delineates the possible etiology of airway narrowing, thus accurately diagnosing airway anomalies.

Magnetic Resonance Imaging of Pediatric Lungs and Airways: New Paradigm for Practical Daily Clinical Use

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.

Radiological Imaging in Chest Diseases: Moving Away from Conventional Modes

A chest radiograph is the most common and the initial radiological investigation for evaluating a child presenting with respiratory complaints. However, performing and interpreting chest radiography optimally requires training and skill. With the relatively easy availability of computed tomography (CT) scanning and more recently multidetector computed tomography (MDCT), these investigations are often performed. Although these can be the cross-sectional imaging modalities of choice in certain situations where detailed and exact anatomical and etiological information is required, both these investigations are associated with increased radiation exposure which has more detrimental effects on children, especially when repeated follow-up imaging is necessary to assess the disease status. Ultrasonography (USG) and magnetic resonance imaging (MRI) have evolved as radiation-free radiological investigations for evaluating the pediatric chest pathologies over the last few years. In the present review article, the utility and the current status, as well as the limitations of USG and MRI for evaluation of pediatric chest pathologies, are discussed. Radiology has grown beyond having just the diagnostic capabilities in managing children with chest disorders in the last two decades. Image-guided therapeutic procedures (percutaneous and endovascular) are routinely performed in children with pathologies in the mediastinum and lungs. The commonly performed image-guided pediatric chest interventions, including biopsies, fine needle aspiration, drainage procedures and therapeutic endovascular procedures, are also discussed in the current review.

Respiratory Motion Management in Abdominal MRI: Radiology In Training

A 96-year-old woman had a suboptimal evaluation of liver observations at abdominal MRI due to significant respiratory motion. State-of-the-art strategies to minimize respiratory motion during clinical abdominal MRI are discussed.

Practical protocol for lung magnetic resonance imaging and common clinical indications

Imaging speed, spatial resolution and availability have made CT the favored cross-sectional imaging modality for evaluating various respiratory diseases of children - but only for the price of a radiation exposure. MRI is increasingly being appreciated as an alternative to CT, not only for offering three-dimensional (3-D) imaging without radiation exposure at only slightly inferior spatial resolution, but also for its superior soft-tissue contrast and exclusive morpho-functional imaging capacities beyond the scope of CT. Continuing technical improvements and experience with this so far under-utilized modality contribute to a growing acceptance of MRI for an increasing number of indications, in particular for pediatric patients. This review article provides the reader with practical easy-to-use protocols for common clinical indications in children. This is intended to encourage pediatric radiologists to appreciate the new horizons for applications of this rapidly evolving technique in the field of pediatric respiratory diseases.

Pediatric cardiothoracic vasculitis: multimodality imaging review

The pediatric vasculitides are a relatively uncommon and heterogeneous group of disorders characterized by vessel inflammation, often with cardiothoracic involvement. Diagnosis and monitoring are often clinically challenging because of the nonspecific symptoms and laboratory markers. Thus, imaging has assumed increasing importance for early detection of disease activity, extent and complications as well as long-term monitoring pre- and post-treatment. Herein, we review the major pediatric vasculitides with frequent chest manifestations, including Takayasu arteritis, Kawasaki disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, Behçet disease and potential mimics. We highlight key clinical features and management considerations, emphasizing the central role of imaging.