Abstract
Continuing advances in multidetector computed tomography (MDCT) technology are revolutionizing the non-invasive evaluation of congenital and acquired large airway disorders in children. For example, the faster scanning time and increased anatomical coverage that are afforded by MDCT are especially beneficial to children. MDCT also provides high-quality multiplanar 2-dimensional (2-D), internal and external volume-rendering 3-dimensional (3-D), and dynamic 4-dimensional (4-D) imaging. These advances have enabled CT to become the primary non-invasive imaging modality of choice for the diagnosis, treatment planning, and follow-up evaluation of various large airway disorders in infants and children. It is thus essential for radiologists to be familiar with safe and effective techniques for performing MDCT and to be able to recognize the characteristic imaging appearances of large airway disorders affecting children.
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Lee EY, Greenberg SB, Boiselle PM (2011) Multidetector computed tomography of pediatric large airway diseases: state-of-the-art. Radiol Clin North Am 49:869–893
Lee EY (2008) Advancing CT and MRI imaging of the lungs and airways in children: imaging into practice. Pediatr Radiol 38(Suppl 2):S208–S212
Lee EY, Siegel MJ (2008) Pediatric airways disorders: large airways. Humana Press, Totowa, NJ
Lee EY, Siegel MJ (2007) MDCT of tracheobronchial narrowing in pediatric patients. J Thorac Imaging 22:300–309
Lee EY, Boiselle PM (2009) Tracheobronchomalacia in infants and children: multidetector CT evaluation. Radiology 252:7–22
Hong SJ, Goo HW, Roh JL (2008) Utility of spiral and cine CT scans in pediatric patients suspected of aspirating radiolucent foreign bodies. Otolaryngol Head Neck Surg 138:576–580
Goo HW, Kim HJ (2006) Detection of air trapping on inspiratory and expiratory phase images obtained by 0.3-second cine CT in the lungs of free-breathing young children. AJR Am J Roentgenol 187:1019–1023
Lee EY, Boiselle PM, Cleveland RH (2008) Multidetector CT evaluation of congenital lung anomalies. Radiology 247:632–648
Lee EY, Boiselle PM, Shamberger RC (2010) Multidetector computed tomography and 3-dimensional imaging: preoperative evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patients. J Pediatr Surg 45:811–821
Lee EY, Restrepo R, Dillman JR et al (2012) Imaging evaluation of pediatric trachea and bronchi: systematic review and updates. Semin Roentgenol 47:182–196
Donnelly LF, Frush DP (2003) Pediatric multidetector body CT. Radiol Clin North Am 41:637–655
Frush DP, Herlong JR (2005) Pediatric thoracic CT angiography. Pediatr Radiol 35:11–25
Ramachandran N, Owens CM (2008) Imaging of the airways with multidetector row computed tomography. Paediatr Respir Rev 9:69–76
Pappas JN, Donnelly LF, Frush DP (2000) Reduced frequency of sedation of young children with multisection helical CT. 215:897–899
Mason KP, Zurakowski D, Zucker EJ et al (2013) Image quality of thoracic 64-MDCT angiography: imaging of infants and young children with or without general anesthesia. AJR Am J Roentgenol 200:171–176
Lee EY, Browne LP, Lam W (2012) Noninvasive magnetic resonance imaging of thoracic large vessels in children. Semin Roentgenol 47:45–55
Krishnamurthy R, Lee EY (2012) Congenital cardiovascular malformations: noninvasive imaging by MRI in neonates. Magn Reson Imaging Clin N Am 19:813–822
Hellinger JC, Daubert M, Lee EY et al (2011) Congenital thoracic vascular anomalies: evaluation with state-of-the-art MR imaging and MDCT. Radiol Clin North Am 49:969–996
Yikilmaz A, Koc A, Coskun A et al (2011) Evaluation of pneumonia in children: comparison of MRI with fast imaging sequences at 1.5 T with chest radiographs. Acta Radiol 52:914–919
Lee EY, Sun Y, Zurakowski D et al (2009) Hyperpolarized 3He MR imaging of the lung: normal range of ventilation defects and PFT correlation in young adults. J Thorac Imaging 24:110–114
Lee EY, Dorkin H, Vargas SO (2011) Congenital pulmonary malformations in pediatric patients: review and update on etiology, classification, and imaging findings. Radiol Clin North Am 49:921–948
Lee EY, Mason KP, Zurakowski D et al (2008) MDCT assessment of tracheomalacia in symptomatic infants with mediastinal aortic vascular anomalies: preliminary technical experience. Pediatr Radiol 38:82–88
Lee EY, Zurakowski D, Waltz DA et al (2008) MDCT evaluation of the prevalence of tracheomalacia in children with mediastinal vascular anomalies. J Thorac Imaging 23:258–265
Lee EY, Litmanovich D, Boiselle PM (2009) Multidetector CT evaluation of tracheobronchomalacia. Radiol Clin North Am 47:261–269
Ridge CA, O’Donnell CR, Lee EY et al (2011) Tracheomalacia: current concepts and controversies 26:278–289
Tan JZ, Ditchfield M, Freezer N (2012) Tracheobronchomalacia in children: review of diagnosis and definition. Pediatr Radiol 42:906–915 quiz 1027–1028
Lee KS, Boiselle PM (2010) Update on multidetector computed tomography imaging of the airways. J Thorac Imaging 25:112–124
Boiselle PM, Lee KS, Lin S et al (2006) Cine CT during coughing for assessment of tracheomalacia: preliminary experience with 64-MDCT. AJR Am J Roentgenol 187:W175–W177
Frush DP (2011) CT dose and risk estimates in children. Pediatr Radiol 41(Suppl 2):482–487
Li X, Samei E, Segars WP et al (2011) Patient-specific radiation dose and cancer risk for pediatric chest CT. Radiology 259:862–874
Frush DP (2008) Pediatric dose reduction in computed tomography. Health Phys 95:518–527
Paterson A, Frush DP (2007) Dose reduction in paediatric MDCT: general principles. Clin Radiol 62:507–517
Strauss KJ, Goske MJ, Kaste SC et al (2010) Image gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR Am J Roentgenol 194:868–873
Lee EY, Strauss KJ, Tracy DA et al (2010) Comparison of standard-dose and reduced-dose expiratory MDCT techniques for assessment of tracheomalacia in children. Acad Radiol 17:504–510
Remy-Jardin M, Remy J, Artaud D et al (1998) Volume rendering of the tracheobronchial tree: clinical evaluation of bronchographic images. Radiology 208:761–770
Remy-Jardin M, Remy J, Artaud D et al (1998) Tracheobronchial tree: assessment with volume rendering-technical aspects. Radiology 208:393–398
Boiselle PM, Ernst A (2002) Recent advances in central airway imaging. Chest 121:1651–1660
Boiselle PM, Reynolds KF, Ernst A (2002) Multiplanar and three-dimensional imaging of the central airways with multidetector CT. AJR Am J Roentgenol 179:301–308
Lee EY, Zurakowski D, Bastos MD et al (2012) Evaluation of image quality and patient safety: paired inspiratory and expiratory MDCT assessment of tracheobronchomalacia in paediatric patients under general anesthesia with breath-hold technique. J Med Imaging Radiat Oncol 56:151–157
Boiselle PM, O’Donnell CR, Bankier AA et al (2009) Tracheal collapsibility in healthy volunteers during forced expiration: assessment with multidetector CT. Radiology 252:255–262
Lee EY, Tracy DA, Bastos M et al (2010) Expiratory volumetric MDCT evaluation of air trapping in pediatric patients with and without tracheomalacia. AJR AM J Roentgenol 194:1210–1215
Kroft LJ, Roelofs JJ, Geleijins J (2010) Scan time and patient dose for thoracic imaging in neonates and small children using axial volumetric 320-detector row CT compared to helical 64-, 32-, and 16- detector row CT acquisitions. Pediatr Radiol 40:294–300
Carden KA, Boiselle PM, Waltz DA et al (2005) Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest 127:984–1005
Lee EY (2007) MDCT and 3D evaluation of type 2 hypoplastic pulmonary artery sling associated with right lung agenesis, hypoplastic aortic arch, and long segment tracheal stenosis. J Thorac Imaging 22:346–350
Berrocal T, Madrid C, Novo S et al (2004) Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics 24:e17
Ghaye B, Szapiro D, Fanchamps JM et al (2001) Congenital bronchial anomalies revisited. Radiographics 21:105–119
O’Sullivan BP, Frassica JJ, Rayder SM (1998) Tracheal bronchus: a cause of prolonged atelectasis in intubated children. Chest 113:537–540
Sugandhi N, Sharma P, Agarwala S et al (2011) Esophageal lung: presentation, management, and review of literature. J Pediatr Surg 46:1634–1637
Ming Z, Lin Z (2007) Evaluation of tracheal bronchus in Chinese children using multidetector CT. Pediatr Radiol 37:1230–1234
Ritsema GH (1983) Ectopic right bronchus: indications for bronchography. AJR Am J Roentgenol 140:671–674
Kumagae Y, Jinguji M, Tanaka D et al (2006) An adult case of bilateral true tracheal bronchi associated with hemoptysis. J Thorac Imaging 21:293–295
Laing MR, Albert DM, Quinney RE et al (1990) Tracheal stenosis in infants and young children. J Laryngol Otol 104:229–235
Shikhani AH, Jones MM, Marsh BR et al (1986) Infantile subglottic hemangiomas. An update. Ann Otol Rhinol Laryngol 95:336–347
Koplewitz BZ, Springer C, Slasky BS et al (2005) CT of hemangiomas of the upper airways in children. AJR Am J Roentgenol 184:663–670
Benjamin B, Parsons DS (1988) Recurrent respiratory papillomatosis: a 10 year study. J Laryngol Otol 102:1022–1028
Bellah RD, Mahboubi S, Berdon WE (1992) Malignant endobronchial lesions of adolescence. Pediatr Radiol 22:563–567
Chong S, Lee KS, Chung MJ et al (2006) Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics 26:41–57
Connor GF, Fishman EK (2004) Endobronchial carcinoid in a child: depiction with three-dimensional volume rendering. Pediatr Radiol 34:1008–1011
Parsons RB, Milestone BN, Adler LP (2003) Radiographic assessment of airway tumors. Chest Surg Clin N Am 13:63–77
Yikilmaz A, Lee EY (2007) CT imaging of mass-like nonvascular pulmonary lesions in children. Pediatric Radiol 37:1253–1263
Magid D, Siegelman SS, Eggleston JC et al (1989) Pulmonary carcinoid tumors: CT assessment. J Comput Assist Tomogr 13:244–247
Granata C, Battistini E, Toma P et al (1997) Mucoepidermoid carcinoma of the bronchus: a case report and review of the literature. Pediatr Pulmonol 23:226–232
Lee EY, Vargas SO, Sawicki GS et al (2007) Mucoepidermoid carcinoma of bronchus in a pediatric patients: (18) F-FDG PET findings. Pediatr Radiol 37:1278–1282
Kim TS, Lee KS, Han J et al (1999) Mucoepidermoid carcinoma of the tracheobronchial tree: radiographic and CT findings in 12 patients. Radiology 212:643–648
Kim TS, Han J, Kim GY et al (2005) Pulmonary inflammatory pseudotumor (inflammatory myofibroblastic tumor): CT features with pathologic correlation. J Comput Assist Tomogr 29:633–639
Uchida DA, Hawkins JA, Coffin CM et al (2009) Inflammatory myofibroblastic tumor in the airway of a child. Ann Thorac Surg 87:610–613
Lee EY (2009) Evaluation of non-vascular mediastinal masses in infants and children: an evidence-based practical approach. Pediatr Radiol 39(Suppl 2):S184–S190
Ranganath SH, Lee EY, Restrepo R et al (2012) Mediastinal masses in children. AJR Am J Roentgenol 198:W197–W216
Gross RE, Neuhauser EB (1948) Compression of the trachea by an anomalous innominate artery: an operation for its relief. Am J Dis Child 75:570–574
Strife JL, Baumel AS, Dunbar JS (1981) Tracheal compression by the innominate artery in infancy and childhood. Radiology 139:73–75
Berdon WE, Baker DH, Bordiuk J et al (1969) Innominate artery compression of the trachea in infants with stridor and apnea. Radiology 92:272–278
Adler SC, Isaacson G, Balsara RK. Innominate artery compression of the trachea: diagnosis and treatment by anterior suspension. A 25-year experience. Ann Otol Rhinol Laryngol 104:924–927
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Lee, E.Y., Zucker, E.J., Restrepo, R. et al. Advanced large airway CT imaging in children: evolution from axial to 4-D assessment. Pediatr Radiol 43, 285–297 (2013). https://doi.org/10.1007/s00247-012-2470-7
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DOI: https://doi.org/10.1007/s00247-012-2470-7