MAGNETIC-RESONANCE-IMAGING OF THE PEDIATRIC AIRWAY

Objective: To determine the role of magnetic resonance imaging (MRI) a nd how it relates to endoscopy as well as to other imaging modalities in the evaluation of pediatric airway disorders. Design: A review stud y of children with various distal airway disorders over a 3-year perio d. Surgical procedures as well as all diagnostic imaging modalities we re reviewed and analyzed with respect to clinical outcome. Setting: Ac ademic tertiary care children's hospitals. Patients: Forty-nine childr en between the ages of 1 week and 14 years with the signs and symptoms of distal airway disorders. Interventions: Forty-five of 49 children underwent airway endoscopy. Fourteen children also underwent fluorosco py and 4 underwent echocardiography. When indicated, open surgical rep air was performed acid used to verify findings in 32 cases. Results: M agnetic resonance imaging was the most accurate modality in defining e xtrinsic airway abnormalities. The findings of echocardiography were i ncorrect in 2 of 4 cases, and fluoroscopy, although accurate for trach eal narrowing and tracheomalacia, often could not elucidate the exact cause or missed left mainstem branchial compression. Furthermore, trac heal narrowing to 50% or greater on MRI correlated 100% with the need for surgical intervention. Conclusions: Magnetic resonance imaging is a useful modality that has allowed us to accurately diagnose extrinsic pediatric tracheal abnormalities. In certain cases, MRI scans can be obtained prior to endoscopy. In those cases, definitive endoscopy and open repair are performed at the same procedure instead of at 2 separa te procedures (ie, one for diagnostic endoscopy and the other for defi nitive repair).