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

Shubham Saini1, Anmol Bhatia1, Joseph L Mathew2

  • 1Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Indian Journal of Pediatrics
|December 2, 2025
PubMed
Summary
This summary is machine-generated.

Low-dose 4D dynamic airways CT accurately diagnoses pediatric stridor, showing high agreement with fiberoptic bronchoscopy (FOB). This non-invasive imaging can assess dynamic airway diseases in children.

Keywords:
4DBronchomalaciaDynamic CTLaryngomalaciaTracheomalacia

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Area of Science:

  • Pediatric Radiology
  • Pulmonology
  • Medical Imaging

Background:

  • Stridor in children often requires diagnostic evaluation for airway abnormalities.
  • Fiberoptic bronchoscopy (FOB) is invasive and may require sedation.
  • Non-invasive imaging modalities are sought for diagnosing pediatric airway diseases.

Purpose of the Study:

  • To evaluate the diagnostic performance of low-dose 4D dynamic airways CT.
  • To compare 4D dynamic airways CT with FOB in children presenting with stridor.
  • To assess the utility of 4D dynamic airways CT as a non-invasive diagnostic tool.

Main Methods:

  • Prospective study of 24 children (13 days - 1.5 years) with stridor.
  • Low-dose 4D dynamic airways CT (70 kVp, 15 mAs) performed during stridor.
  • Comparison of 4D CT findings with FOB (gold standard) for laryngomalacia, tracheomalacia, and bronchomalacia.

Main Results:

  • 4D CT achieved high diagnostic accuracies: 91.6% (laryngomalacia), 95.7% (tracheomalacia), 95.5% (bronchomalacia).
  • Substantial to almost perfect agreement (k=0.777-0.913) was observed between 4D CT and FOB.
  • Sensitivity ranged from 90.9% to 94.4%, and specificity from 80% to 100%.

Conclusions:

  • Low-dose 4D dynamic airways CT demonstrates high diagnostic accuracy for pediatric dynamic airway diseases.
  • The modality shows substantial to almost perfect agreement with FOB.
  • 4D dynamic airways CT is a promising non-invasive tool for evaluating children with stridor.