4D Dynamic CT in Children with Stridor: New Non-Invasive Modality for Airways Assessment - A Pilot Study

To assess the diagnostic utility of low-dose 4D dynamic airways CT in children with stridor as a non-invasive modality compared to fiberoptic bronchoscopy (FOB).

Twenty-four (24) children (age: 13 d - 1.5 y, boys: 18) with stridor who underwent 4D dynamic airways CT and FOB were enrolled in this prospective study. Low-dose 4D dynamic airways CT was performed with 70 kVp and 15 mAs. Stridor during CT acquisition was noted. Image analysis was done using volume-rendered reconstruction and axial images, and the degree of collapse was noted. The 4D CT and FOB findings were compared with FOB as the gold standard.

The diagnostic accuracy of 4D dynamic airway CT was 91.6%, 95.7%, and 95.5% for diagnosing laryngomalacia, tracheomalacia, and bronchomalacia, respectively. The sensitivity and specificity of 4D dynamic airway CT for diagnosing laryngomalacia were 94.4% and 80%, respectively, with substantial agreement between the two modalities (k = 0.777). The sensitivity for detecting tracheomalacia and bronchomalacia was 90.9% and 75%, respectively, with 100% specificity. There was an almost perfect agreement between the two modalities for tracheomalacia (k = 0.913) and bronchomalacia (k = 0.831). The presence of stridor during CT was positively associated with predicting abnormality detection on CT.

4D dynamic airways CT has a high diagnostic accuracy for diagnosing dynamic airway diseases with a substantial to almost perfect agreement with FOB. It may be used as a non-invasive tool for assessing dynamic airway diseases in children.