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Routine multi detector computed tomography evaluation of tracheal impairment compared to laryngo-tracheal endoscopy
Cecile O Muller1, Lucie Derycke2, Ahmed Kheniche3
1Pediatric Surgery Department, Robert Debré Hospital, APHP, 48 bvd Serrurier, 75019, Paris, France. cecile.muller@aphp.fr.
Insights
Multi-detector computed tomography (MDCT) reliably assesses tracheal narrowing in children with vascular rings (VR), comparable to laryngo-tracheal endoscopy. This suggests MDCT can replace endoscopy for evaluating airway issues in pediatric VR cases.
Area of Science:
- Pediatric radiology
- Thoracic surgery
- Congenital heart disease
Background:
- Vascular rings (VR) are congenital anomalies causing tracheal compression in children.
- Evaluating the severity of tracheal impairment is crucial for surgical planning and patient outcomes.
- Laryngo-tracheal (LT) flexible endoscopy is traditionally used, but multi-detector computed tomography (MDCT) offers a non-invasive alternative.
Purpose of the Study:
- To compare the diagnostic accuracy of free-breathing routine multi-detector computed tomography (MDCT) and laryngo-tracheal (LT) flexible endoscopy.
- To assess the evaluation of tracheal impairment in children diagnosed with vascular rings (VR).
Main Methods:
- A retrospective monocentric study included pediatric patients with VR from 1997 to 2014.
- MDCT scans were reviewed by radiologists, and results were compared with LT endoscopy findings.
- Evaluation focused on tracheal narrowing percentage, compression level, bronchial compression, and tracheomalacia (TM), using Spearman correlation for concordance.
Main Results:
- Twenty-one patients with VR underwent surgery; MDCT and LT endoscopy data were analyzed for nine patients.
- Excellent concordance was found for tracheal narrowing percentage and level (Spearman coefficient = 1).
- Good concordance was observed for signs of tracheomalacia (TM) (Spearman coefficient = 0.79).
Conclusions:
- Free-breathing routine MDCT is a reliable tool for evaluating tracheal impairment in children with VR.
- MDCT can potentially replace LT endoscopy in cases with suggestive chest X-rays and respiratory symptoms (excluding stridor).
- This non-invasive approach may streamline diagnosis and management of pediatric vascular ring anomalies.
Purpose:
The aim of this study is to compare free-breathing routine multi detector computed tomography (MDCT) and laryngo-tracheal (LT) flexible endoscopy in the evaluation of tracheal impairment in children with vascular ring (VR).
Materials And Methods:
We performed a retrospective and monocentric study of all patients with VR from 1997 to 2014. Clinical data included: initial symptoms, type of surgery and clinical outcome. MDCT were blindly reviewed by two radiologists in consensus, independently of LT endoscopy results. Radiologic and endoscopic results were reviewed according to four criteria: percentage of tracheal narrowing, distance of the compression from carina, presence of bronchial compression and signs of tracheomalacia (TM). Concordance was evaluated for each criterion with a Spearman coefficient.
Results:
From 1997 to 2016, 21 patients with a vascular ring were operated on, among which 57% by thoracoscopy: double aortic arch (n = 14), Neuhauser anomaly (n = 4) and Right aorta + aberrant right subclavian artery (n = 3). 90% of them presented with respiratory symptoms among which 43% of stridor. Chest X-ray was suggestive of VR in 87% of the cases. MDCT images and LT endoscopy results were available and analyzed for nine patients. Concordance (Spearman correlation coefficient) was excellent for percentage and level of tracheal narrowing (1) and good for TM (0.79).
Conclusion:
Free breathing routine MDCT is a reliable exam compared to LT endoscopy in the evaluation of tracheal impairment in children with VR. In case of respiratory symptoms (except stridor) and suggestive chest X-ray of VR, endoscopy could be avoided and routine MDCT alone performed.
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