Comparison of Standard-Dose and Reduced-Dose Expiratory MDCT Techniques for Assessment of Tracheomalacia in Children

Lee, Edward Y.; Strauss, Keith J.; Tracy, Donald A.; Bastos, Maria D.Almeida; Zurakowski, David; Boiselle, Phillip M.

doi:10.1016/j.acra.2009.11.014

Cited by 42 publications

(33 citation statements)

References 23 publications

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“…[1,4,5] Therefore, only a brief summary of MDCT technique is included in the following paragraphs in this section. All pediatric patients underwent MDCT studies using our department's standard paired inspiratory-expiratory MDCT airway protocol.…”

Section: Imaging Techniquementioning

confidence: 99%

Tracheobronchomalacia in pediatric patients with esophageal atresia: Comparison of diagnostic laryngoscopy/bronchoscopy and dynamic airway multidetector computed tomography

Ngerncham

Lee

Zurakowski

et al. 2015

Journal of Pediatric Surgery

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Section: Imaging Techniquementioning

confidence: 99%

Tracheobronchomalacia in pediatric patients with esophageal atresia: Comparison of diagnostic laryngoscopy/bronchoscopy and dynamic airway multidetector computed tomography

Ngerncham

Lee

Zurakowski

et al. 2015

Journal of Pediatric Surgery

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“…Recent studies in children have shown that radiation exposure can be reduced by up to 23% while maintaining adequate diagnostic yield. 40 An additional challenge is the need for young children to participate in the methods required for MDCT techniques. This makes these techniques unfeasible in infants.…”

Section: E Diagnosis Of Tracheomalaciamentioning

confidence: 99%

Paediatric Tracheomalacia

Hysinger

Panitch

2016

Paediatric Respiratory Reviews

127

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Intrathoracic tracheomalacia is characterized by increased compliance of the central airway within the thorax. This leads to excessive dynamic collapse during exhalation or periods of increased intrathoracic pressure such as crying. Extrathoracic tracheomalacia involves dynamic collapse of the airway between the glottis and sternal notch that occurs during inhalation rather than exhalation. The tone of the posterior membrane of the trachea increases throughout development and childhood, as does the rigidity of the tracheal cartilage. Abnormalities of airway maturation result in congenital tracheomalacia. Acquired tracheomalacia occurs in the normally developed trachea due to trauma, external compression, or airway inflammation. Although tracheomalacia can be suspected by history, physical examination, and supportive radiographic findings, flexible fiberoptic bronchoscopy remains the "gold standard" for diagnosis. Current treatment strategies involve pharmacotherapy with cholinergic agents, positive pressure ventilation, and surgical repair.

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“…In our study, the area with maximal collapse is based on measurements of the cross-sectional areas from the carina to the thoracic inlet. In a study by Lee et al, a radiologist determined the maximal collapse visually, while Ochs et al used a technique similar to ours that minimizes the interobserver variation [13,14]. An important problem with this method is that patients with only minor localized collapse are also included, and the impact of this is unknown and questionable [15].…”

Section: Discussionmentioning

confidence: 99%

Tracheal collapse diagnosed by multidetector computed tomography: evaluation of different image analysis methods

Nyegaard

Bendstrup

Dahl

et al. 2017

European Clinical Respiratory Journal

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Background: The gold standard for diagnosing excessive tracheal collapse is still evaluation during bronchoscopy. Today, multidetector computed tomography (MDCT) is used to confirm a suspicion of abnormal tracheal collapse. There is no gold standard for computed tomography (CT) image analysis of tracheal collapse. Purpose: To evaluate four different methods for the diagnosis of tracheal collapse using the images obtained through MDCT to help clinicians evaluate the images in daily practice. Objectives: 374 consecutive high-resolution CT scans with full inspiratory and end-expiratory CT scans were retrospectively analyzed. Methods: The images were analyzed in four different ways. The degree of collapse was based on cross-sectional areas of individual locations or volumes of entire regions: (1) 1 cm above the carina, (2) the level of maximal collapse of the trachea, (3) the entire region from the carina to the thoracic inlet, and (4) the trachea and bronchial region as defined by the software. Results: We compared three existing and one new method for image analysis of tracheal collapse by MDCT. The prevalence of tracheal collapse varied from 10.7% to 19.5% in this cohort of patients suffering from mixed lung diseases when using an expiratory collapse of ≥50% as a threshold. The four methods were comparable with highly significant Pearsons correlation coefficients (0.764–0.856). However, the four methods identified different patients with collapse of ≥50%. There was no correlation between symptoms and the degree of collapse. Conclusion: The different methods identify tracheal collapse in different patients. Hence, the diagnosis of excessive tracheal collapse can not rely solely on MDCT images. Generally, there is a poor correlation between symptoms and the degree of collapse in the different methods. However, when using the maximal collapse, there is some correlation with symptoms. When in doubt regarding the diagnosis, further investigations, such as bronchoscopy, should be carried out.

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Comparison of Standard-Dose and Reduced-Dose Expiratory MDCT Techniques for Assessment of Tracheomalacia in Children

Cited by 42 publications

References 23 publications

Tracheobronchomalacia in pediatric patients with esophageal atresia: Comparison of diagnostic laryngoscopy/bronchoscopy and dynamic airway multidetector computed tomography

Tracheobronchomalacia in pediatric patients with esophageal atresia: Comparison of diagnostic laryngoscopy/bronchoscopy and dynamic airway multidetector computed tomography

Paediatric Tracheomalacia

Tracheal collapse diagnosed by multidetector computed tomography: evaluation of different image analysis methods

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