Magnetic resonance imaging findings in pediatric neck infections—a comparison with adult patients

Abstract

Background Differences in the functioning of the immune system and the anatomical proportions of the neck between children and adults lead to different manifestations of deep neck infections. Magnetic resonance imaging (MRI) may serve as an alternative to computed tomography (CT) as the primary imaging modality. Objective To study characteristic MRI findings and the diagnostic accuracy of MRI in pediatric deep neck infections. Materials and methods We retrospectively studied a cohort of pediatric patients who underwent a neck 3-tesla MRI study over a five-year period. Inclusion criteria were: 1) emergency MRI findings indicating an infection, 2) infection as the final clinical diagnosis, 3) diagnostic image quality verified by the radiologist reading the study and 4) age under 18 years. Patient record data, including surgery reports, were compared with the MRI findings. Results Data of 45 children were included and analysed. Compared to adults, children had a higher incidence of retropharyngeal infection and lymphadenitis, and a lower incidence of peritonsillar/parapharyngeal infection. MRI showed evidence of an abscess in 34 children. Of these 34 patients, 24 underwent surgery, which confirmed an abscess in 21 but no abscess in three patients. In addition, three patients underwent surgery without MRI evidence of abscess, and an abscess was found in one of these cases. The measures of diagnostic accuracy among the children were sensitivity 0.96, specificity 0.77, positive predictive value 0.89, negative predictive value 0.91 and accuracy 0.89. Compared with adults, children had lower C-reactive protein, but a similar proportion of them had an abscess, and abscess size and rate of surgery were similar. Conclusion Despite the differences in the infection foci, emergency MRI in children had equal diagnostic accuracy to that in adults.

Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value

“…Defined this way, the diagnosis of an abscess has substantial interobserver reliability. PPV of MRI for diagnosing surgically confirmed abscesses is very high (0.95) [58][59][60][61][62], which is clinically meaningful, because many patients with positive abscess finding on imaging undergo surgery. To put these numbers from both modalities in perspective, a PPV of 0.83 for CT may result in unnecessary surgery in approximately 1 in 6 patients, compared with 1 in 20 patients for MRI.…”

MRI of acute neck infections: evidence summary and pictorial review

“…Some patient-related contraindications may favor the use of CT instead of MRI, such as ferromagnetic foreign objects, restlessness, claustrophobia, high fever, and difficult dyspnea. In addition to adults, the high feasibility and equal diagnostic accuracy of emergency MRI have been demonstrated in children [ 8 ].…”

“…This diagnostic accuracy is much higher than previously reported for contrast-enhanced CT, for which the PPV is about 0.80 in clinical studies [ 5 – 7 ]. High diagnostic accuracy was subsequently confirmed separately in pharyngotonsillar (accuracy 0.97) [ 10 ], odontogenic (accuracy 0.92) [ 11 ], and pediatric (accuracy 0.89) [ 8 ] neck infections. False positive and negative abscess diagnoses are rare (Fig.…”

“…Because many younger children require sedation or anesthesia for MRI, choosing an appropriate emergency imaging method for a suspected neck infection is a balance between the potential harm of radiation and the possible immediate or long-term harm related to anesthesia [ 30 ]. About a third of children required sedation with spontaneous breathing, whereas the minority required general anesthesia and intubation [ 8 ].…”

Paediatric Deep Neck Infection—The Risk of Needing Intensive Care

“…The accuracy of CT and MRI is comparable in diagnosing deep neck abscesses. CT or MRI should be preferred in patients with an aggravating clinical course or compromised airways [ 61 , 62 , 63 , 64 , 65 , 66 ].…”