Article Text
Abstract
Rationale Paediatric laryngotracheal stenosis (LTS) is often successfully corrected with open airway surgery. However, respiratory and vocal sequelae frequently remain. Clinical care and surgical interventions could be improved with better understanding of these sequelae.
Objective The objective of this cross-sectional study was to develop an upper airway MRI protocol to obtain information on anatomical and functional sequelae post-LTS repair.
Methods Forty-eight patients (age 14.4 (range 7.5–30.7) years) and 11 healthy volunteers (15.9 (8.2–28.8) years) were included. Spirometry and static and dynamic upper airway MRI (3.0 T, 30 min protocol) were conducted. Analysis included assessment of postoperative anatomy and airway lumen measurements during static and dynamic (inspiration and phonation) acquisitions.
Main results Good image quality without artefacts was achieved for static and dynamic images in the majority of MRIs. MRI showed vocal cord thickening in 80.9% of patients and compared with volunteers, a significant decrease in vocal cord lumen area (22.0 (IQR 17.7–30.3) mm2 vs 35.1 (21.2–54.7) mm2, p=0.03) but not cricoid lumen area (62.3±27.0 mm2 vs 66.2±34.8 mm2, p=0.70). Furthermore, 53.2% of patients had an A-frame deformation at site of previous tracheal cannula, showing lumen collapse during inspiration. Dynamic imaging showed incomplete vocal cord abduction during inspiration in 42.6% and incomplete adduction during phonation in 61.7% of patients.
Conclusions Static and dynamic MRI is an excellent modality to non-invasively image anatomy, tissue characteristics and vocal cord dynamics of the upper airways. MRI-derived knowledge on postsurgical LTS sequelae might be used to improve surgery.
- imaging/CT MRI etc
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Footnotes
Contributors BE contributed to the design of the work, data collection and analysis, drafted the manuscript and gave final approval to the manuscript. PC contributed to the design of the work, data analysis, critically revised the manuscript and gave final approval to the manuscript. HT contributed to the design of the work, critically revised the manuscript and gave final approval to the manuscript, WvdB contributed to data analysis, critically revised the manuscript and gave final approval to the manuscript, PW contributed to the design of the study and data collection, critically revised the manuscript and gave approval to the final version of the manuscript. BP contributed to the design of the work and data analysis, critically revised the manuscript and gave final approval to the manuscript.
Funding This study was funded by Vrienden van het Sophia (B17-02-Step 2017).
Competing interests None declared.
Patient consent for publication Obtained.
Ethics approval This study was approved by the local medical ethics review board (MEC-2018–013).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Data consist of deidentified patient data such as clinical data and MRIs saved in the electronic patient file and research analyses. All data are available from the corresponding author, after permission.