Korean J Radiol.  2007 Dec;8(6):506-511. 10.3348/kjr.2007.8.6.506.

Upper Airway Volume Segmentation Analysis Using Cine MRI Findings in Children with Tracheostomy Tubes

• Fricke BL
• Abbott MB
• Donnelly L
• Dardzinski BJ
• Poe SA
• Kalra M
• Amin RS
• Cotton RT

• KMID: 1089438
• DOI: http://doi.org/10.3348/kjr.2007.8.6.506

Abstract

OBJECTIVE: The purpose of this study is to evaluate the airway dynamics of the upper airway as depicted on cine MRI in children with tracheotomy tubes during two states of airflow through the upper airway. MATERIALS AND METHODS: Sagittal fast gradient echo cine MR images of the supra-glottic airway were obtained with a 1.5T MRI scanner on seven children with tracheotomy tubes. Two sets of images were obtained with either the tubes capped or uncapped. The findings of the cine MRI were retrospectively reviewed. Volume segmentation of the cine images to compare the airway volume change over time (mean volume, standard deviation, normalized range, and coefficient of variance) was performed for the capped and uncapped tubes in both the nasopharynx and hypopharynx (Signed Rank Test). RESULTS: Graphical representation of the airway volume over time demonstrates a qualitative increased fluctuation in patients with the tracheotomy tube capped as compared to uncapped in both the nasopharyngeal and hypopharyngeal regions of interest. In the nasopharynx, the mean airway volume (capped 2.72 mL, uncapped 2.09 mL, p = 0.0313), the airway volume standard deviation (capped 0.42 mL, uncapped 0.20 mL, p = 0.0156), and the airway volume range (capped 2.10 mL, uncapped 1.09 mL, p = 0.0156) were significantly larger in the capped group of patients. In the hypopharynx, the airway volume standard deviation (capped 1.54 mL, uncapped 0.67 mL, p = 0.0156), and the airway volume range (capped 6.44 mL, uncapped 2.93 mL, p = 0.0156) were significantly larger in the capped tubes. The coefficient of variance (capped 0.37, uncapped 0.26, p = 0.0469) and the normalized range (capped 1.52, uncapped 1.09, p = 0.0313) were significantly larger in the capped tubes. CONCLUSION: There is a statistically significant change in airway dynamics in children with tracheotomy tubes when breathing via the airway as compared to breathing via the tracheotomy tube.

Keyword

Magnetic resonance (MR), cine study; Airway, MR; Obstructive sleep apnea, children

MeSH Terms

Adolescent
Child
Child, Preschool
Female
Humans
Hypopharynx/anatomy & histology/*physiology
Image Processing, Computer-Assisted
Magnetic Resonance Imaging, Cine/*methods
Male
Nasopharynx/anatomy & histology/*physiology
Retrospective Studies
Time Factors
Tracheostomy/*instrumentation
Work of Breathing/*physiology

Figure

• 

  Fig. 1 Sagittal cine MR images obtained with a 1.5T scanner in an 11-year-old boy with difficulty in tracheotomy tube decannulation, with the tracheotomy tube capped. A. Gradient-recalled-echo cine image. The line shows the region of interest of the nasopharynx. B. Gradient-recalled-echo cine image. The line shows the region of interest of the hypopharynx.

• 

  Fig. 2 Sagittal cine MR images obtained with a 1.5T scanner in an 11-year-old boy with difficulty in tracheotomy tube decannulation. A, B. An image obtained with the tracheotomy tube capped (A) shows a larger patent nasopharynx (arrowheads) and hypopharynx (arrows) as compared to the image obtained with the tracheotomy tube uncapped (B).

• 

  Fig. 3 Plot of volume versus time of the hypopharynx with the tracheotomy tube capped and uncapped in an 11-year-old boy with difficulty in tracheotomy tube decannulation, displaying increased airway dynamics in the capped series.

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  Fig. 4 Plot of volume versus time of the hypopharynx with the tracheotomy tube capped and uncapped in a 9-year-old boy with difficulty in tracheotomy tube decannulation, displaying increased airway dynamics in the capped series, but with a similar mean airway volume.

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