Magnetic resonance imaging accuracy before surgery in children with retropharyngeal abscesses

Abstract

Aims: Retropharyngeal abscess (RPA) is a deep neck infection occurring in childhood. The gold standard technique for diagnosis is computerised tomography (CT) with a contrast medium. The aim of this study is to answer the question of whether magnetic resonance imaging (MRI) can be an alternative in diagnosing RPA and predicting pus drainage at surgery. Methods: This is a retrospective study conducted at the paediatric emergency department of a tertiary level children hospital. The medical records of 31 children admitted to the Otorhinolaryngology and Paediatric ward, with a suspected diagnosis of RPA, were reviewed. The primary study outcome was the diagnostic accuracy of CT and MRI in predicting the amount of pus during surgery. Results: Twenty-two patients (71%) underwent surgery. Among them, 18 had imaging before surgery. Eleven patients evaluated with CT scan underwent surgery: four had non-significant purulent drainage, three of them were reported to have a significant fluid collection (negative predictive value 66% and positive predictive value of 55%). Nine patients evaluated with MRI underwent surgery: four cases had non-significant purulent drainage, three of them showed a significant fluid collection at MRI (negative predictive value of 60%; positive predictive value of 56%). Conclusion: MRI and CT scans showed similar accuracy in predicting successful pus drainage during surgery; therefore, it could be a valid alternative in the diagnosis of RPA in children.

Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children

“…In an attempt to avoid exposure to ionizing radiation, the use of magnetic resonance imaging (MRI) is being analyzed. In the study by Conte et al they observed that CT and MRI showed similar accuracy in predicting successful pus drainage during surgery [ 27 ]. Zhao et al described the use of CT and ultrasound (US) imaging for the evaluation of neck infections in pediatric patients, and they concluded that children with neck infections evaluated in general emergency departments are significantly more likely to undergo CT scans when compared to those evaluated by pediatricians [ 28 ].…”

Paediatric Deep Neck Infection—The Risk of Needing Intensive Care

“…The accuracy of CT and MRI is comparable in diagnosing deep neck abscesses. CT or MRI should be preferred in patients with an aggravating clinical course or compromised airways [ 61 , 62 , 63 , 64 , 65 , 66 ].…”