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Helical multi‐detector CT scan as a tool for diagnosing tracheomalacia in children
Author(s) -
Douros Konstantinos,
Kremmydas Gerasimos,
Grammeniatis Vasilis,
Papadopoulos Marios,
Priftis Kostas N.,
Alexopoulou Efthymia
Publication year - 2019
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24188
Subject(s) - medicine , tracheomalacia , expiration , radiology , bronchoscopy , diagnostic accuracy , computed tomography , nuclear medicine , respiratory system , airway , surgery
Background/Aims Tracheomalacia (TM) is not an unusual diagnosis in pediatric respiratory clinics. The aim of this study was to assess the accuracy of paired static end‐inspiratory/end‐expiratory helical multi‐detector CT scan (MDCT) in detecting TM. Methods FB was performed in 28 children suspected of TM on the grounds of presence of recurrent episodes of vibrating cough and a need for more specific diagnostic information. Children diagnosed with flexible bronchoscopy (FB) as having TM were further investigated with MDCT. The cross‐sectional area ratio of the trachea during end‐expiration and end‐inspiration, at the level of maximum end‐expiration collapse (CSR), determined the basis for the MDCT diagnosis of TM. FB and MDCT were also performed in five children who suffered from mainly dry—but not honking, barking, or vibrating—cough for more than 3 months, and served as controls. Results The diagnosis of TM was established bronchoscopically in 26 out of 28 children. CRS was significantly smaller in patients (0.59 ± 0.14) compared with controls (0.85 ± 0.11) ( P = 0.001). The optimal CSR cut‐off point for TM diagnosis, as it was estimated by the ROC curve, was ≤0.705 (95%CI: ≤0.635‐≤0.850) with a sensitivity 84.6% (95%CI: 65.1‐95.6), and specificity 100.0% (95%CI: 47.8‐100.0). Conclusions MDCT can effectively diagnose TM in the majority of children and can be used as an alternative to FB. In children, the established criterion of CSR ≤0.5 should be replaced by CSR ≤0.7 that seems to be a more appropriate threshold.