MRI in Children With Pyriform Sinus Fistula

Abstract

Background A variety of imaging modalities have been described for the diagnosis of congenital pyriform sinus fistula (CPSF). To date, there have been few MRI reports. Purpose To evaluate MRI findings of CPSF and interobserver reliability. Study Type Retrospective. Population In all, 115 patients aged 23 days to 15.4 years at operation. Field Strength/Sequence 3.0T/axial T1‐weighted image (T1WI)‐SPIR, axial T2WI, axial T2WI‐STIR, coronal T2WI‐SPIR, diffusion‐weighted imaging (DWI), axial and coronal gadolinium‐enhanced T1WI‐SPIR. Assessment For each patient, the medical records, including demographics, clinical manifestations, and MRI findings were reviewed. All the MRI studies were interpreted by three radiologists independently. Statistical Test Kendall's W test was made to determine the interobserver reliability of three reviewers for MRI findings. Results CPSF occurred on the left side in 104 (90.4%) patients and on the right side in 11 (9.6%) patients. The male‐to‐female ratio was 59:56. The age at first episode varied from birth to 12.3 years. There was one neonate patient, who presented with a unilocular cystic mass in the left neck. A tunnel‐like lesion between the pyriform fossa and the upper pole of the thyroid gland, T2 high signal behind the cricothyroid joint, thyroid gland involvement, deep neck abscesses or masses were noted in 46 (40%), 93 (80.9%), 96 (83.5%), and 36 (31.3%) patients, respectively. There was excellent interobserver reliability for all the MRI findings, ranging from 0.84 to 1.00. Data Conclusion The sinus tract presenting with a tunnel‐like lesion goes behind the cricothyroid joint in most cases. For patients presenting with acute suppurative thyroiditis (AST) or neck infection with thyroid gland involvement, the presence of T2 high signal behind the cricothyroid joint highly suggests the diagnosis of CPSF. MRI is a reliable method for the diagnosis of CPSF. Level of Evidence 4 Technical Efficacy Stage 2

Imaging Findings in Neonates With Congenital Pyriform Sinus Fistula: A Retrospective Study of 45 Cases

“…Only 15 cystic masses with air bubbles were diagnosed as CPSF by US clinically. The sign of air-bubbles in the cyst was identified as the characteristic indicator of CPSF in previous studies (18). Our results were comparable with those of the studies, reporting 15 air-bubble cysts diagnosed on US and 24 air-bubble cysts diagnosed on CT. Obviously, CT showed significantly higher detection rates of the air-bubble sign in lesions than US, which may be explained by the fact that the amount of air filled in the lesions was usually small and the individual bias of the US operators.…”

“…CPSF in the neonates showed other distinctive imaging findings on contrast-enhanced CT scan, especially having advantages in terms of confirming the exact location and extent of involvement of a lesion, which is helpful to diagnose the CPSF without specific air bubbles. Based on the anatomical location of the cervical fascial space ( 19 , 20 ), these lesions were located in the visceral space, as a characteristic imaging manifestation of the disease ( 18 ). With the higher spatial and density resolution than the US, CT is more sensitive in detecting the relationship between cysts with the retropharyngeal space, mediastinum, thyroid, and airway.…”

“…However, neonatal CPSF usually involves mild inflammation that does not cause acute suppurative thyroiditis and is characterized by the formation of a large cyst that causes respiratory distress ( 13 ). When CPSF continues until childhood, it leads to adhesion to surrounding tissue structures and the opening of the pyriform sinus to the fistula becomes inflammation stenosis progressively ( 9 , 18 , 22 ). That is why the symptoms and management of CPSF differ between neonates and children.…”

A safe and effective surgical method for complex pyriform sinus fistula

“…The typical presentations of lesions in pyriform sinus fistula are recurrent low‐neck abscesses, acute suppurative thyroiditis, and neck masses 14–16 . Approximately, 90% of these sinus tracts are situated on the left side of the neck, which may be due to embryonic development 17–19 . An internal fistula is usually located at the tip or base of the pyriform fossa 20,21 .…”

The application value of computed tomography and magnetic resonance imaging sinography/fistulography in evaluating chronic wounds: a prospective study

“…Previous studies have reported the application of computed tomography (CT) and magnetic resonance imaging (MRI) in imaging evaluation of chronic wounds (8)(9)(10)(11)(12); CT scan relay high anatomic detail of chronic wounds and assess surrounding bone destruction (3), and MRI has high resolution and sensitivity to soft tissue without ionizing radiation. It is possible to combine CT and MRI with sinography/fistulography, which allows for visualization of internal features of the sinus/fistula by instilling contrast agent into the external opening (9).…”