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Magnetic resonance imaging accuracy before surgery in children with retropharyngeal abscesses
Mariasole Conte1, Francesco Vinci2, Enrico Muzzi3
1Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
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.
Insights
Magnetic resonance imaging (MRI) and computed tomography (CT) scans show similar accuracy in diagnosing pediatric retropharyngeal abscess (RPA) and predicting surgical pus drainage. Either imaging modality can be a viable alternative for RPA diagnosis in children.
Area of Science:
- Pediatric deep neck infections
- Diagnostic imaging in children
- Otorhinolaryngology
Background:
- Retropharyngeal abscess (RPA) is a serious deep neck infection in children.
- Computed tomography (CT) with contrast is the current gold standard for RPA diagnosis.
- Accurate diagnosis is crucial for effective surgical planning and treatment.
Purpose of the Study:
- To evaluate magnetic resonance imaging (MRI) as an alternative diagnostic tool for pediatric RPA.
- To compare the accuracy of MRI and CT in predicting surgical pus drainage.
- To assess the diagnostic performance of imaging in guiding RPA management.
Main Methods:
- Retrospective study of 31 children with suspected RPA at a tertiary children's hospital.
- Review of medical records, focusing on imaging findings (CT and MRI) and surgical outcomes.
- Analysis of diagnostic accuracy in predicting the amount of pus drained during surgery.
Main Results:
- Both CT and MRI demonstrated comparable accuracy in predicting surgical pus drainage.
- CT had a negative predictive value of 66% and a positive predictive value of 55%.
- MRI had a negative predictive value of 60% and a positive predictive value of 56%.
Conclusions:
- MRI is a potentially valid alternative to CT for diagnosing RPA in children.
- Imaging accuracy for predicting pus drainage is similar between MRI and CT.
- These findings support the use of MRI in the diagnostic workup of pediatric RPA.
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