Upper airway volume segmentation analysis using cine MRI findings in children with tracheostomy tubes.
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.


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.


CONCLUSIONS
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.
Fricke
Bradley L
BL
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati OH 45229, USA.
Abbott
M Bret
MB
Donnelly
Lane F
LF
Dardzinski
Bernard J
BJ
Poe
Stacy A
SA
Kalra
Maninder
M
Amin
Raouf S
RS
Cotton
Robin T
RT
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007013:Hypopharynx / Q000033:anatomy & histology / Q000502:physiology*; D007091:Image Processing, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009305:Nasopharynx / Q000033:anatomy & histology / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation*; D014939:Work of Breathing / Q000502:physiology*