Evaluation of Complex Upper Airway Obstruction in Children Using Cine-MRI: A Single-Center Experience and Literature Review.

Abstract

Introduction Polysomnography (PSG) is considered the gold standard diagnostic test for obstructive sleep apnea (OSA) in children. However, the anatomic location of upper airway obstruction in these patients cannot be determined by PSG, especially in children with complex upper airway obstruction. CT imaging and endoscopic evaluation have been proposed for the evaluation of upper airways in these children. However, cinematic magnetic resonance imaging (Cine-MRI) is a safer, less invasive, and potentially more useful tool for dynamic and anatomical evaluation of upper airways. We here describe the diagnostic outcomes of Cine-MRI in our cohort of children with OSA and suspected complex upper airway obstruction. Methods A retrospective chart review of clinical and radiological data of all children with PSG confirmed diagnosis of OSA and who underwent upper airway evaluation using Cine-MRI. Upper airways were evaluated at three different levels: nasopharynx, oropharynx, and supraglottic, during both inspiration and expiration. Fractional collapse (FC) at different levels was used to evaluate dynamic airway collapse and was defined as the difference between maximum and minimum airway dimensions divided by the maximum dimensions. Results Eight children (five females and three males) were included. Median age was 8.5 months (range: one month to 16 years). Cine-MRIs identified upper airway obstruction in all patients. Additionally, 50% of the patients had more than one level of obstruction, mainly the nasopharynx and oropharynx. There was a positive correlation between the apnea-hypopnea index (AHI) and FC in the anteroposterior dimension at the nasopharyngeal and the oropharyngeal levels, but it did not reach statistical significance. However, there was a statistically significant negative correlation between AHI and FC in the transverse dimension at the oropharyngeal level. Cine-MRI was helpful in continuous positive airway pressure (CPAP) titration in two patients and was helpful in planning surgical intervention in two patients. Conclusion Cine-MRI is a helpful diagnostic tool in evaluating patients with complex upper airway obstruction and can direct potential surgical and non-surgical intervention in pediatric patients with complex upper airway obstruction.