Upper Airway Volume Segmentation Analysis Using Cine MRI Findings in Children with Tracheostomy Tubes

Abstract

ObjectiveThe purpose of this study is to evaluate the airway dynamics of the upper airway as depicted on cine MRI in children with tracheotomy tubes during two states of airflow through the upper airway.Materials and MethodsSagittal fast gradient echo cine MR images of the supra-glottic airway were obtained with a 1.5T MRI scanner on seven children with tracheotomy tubes. Two sets of images were obtained with either the tubes capped or uncapped. The findings of the cine MRI were retrospectively reviewed. Volume segmentation of the cine images to compare the airway volume change over time (mean volume, standard deviation, normalized range, and coefficient of variance) was performed for the capped and uncapped tubes in both the nasopharynx and hypopharynx (Signed Rank Test).ResultsGraphical representation of the airway volume over time demonstrates a qualitative increased fluctuation in patients with the tracheotomy tube capped as compared to uncapped in both the nasopharyngeal and hypopharyngeal regions of interest. In the nasopharynx, the mean airway volume (capped 2.72 mL, uncapped 2.09 mL, p = 0.0313), the airway volume standard deviation (capped 0.42 mL, uncapped 0.20 mL, p = 0.0156), and the airway volume range (capped 2.10 mL, uncapped 1.09 mL, p = 0.0156) were significantly larger in the capped group of patients. In the hypopharynx, the airway volume standard deviation (capped 1.54 mL, uncapped 0.67 mL, p = 0.0156), and the airway volume range (capped 6.44 mL, uncapped 2.93 mL, p = 0.0156) were significantly larger in the capped tubes. The coefficient of variance (capped 0.37, uncapped 0.26, p = 0.0469) and the normalized range (capped 1.52, uncapped 1.09, p = 0.0313) were significantly larger in the capped tubes.ConclusionThere is a statistically significant change in airway dynamics in children with tracheotomy tubes when breathing via the airway as compared to breathing via the tracheotomy tube.

An integrated model-driven method for in-treatment upper airway motion tracking using cine MRI in head and neck radiation therapy

“…The previous studies with 3D pre-and post-treatment MRI images validated this. [13][14][15][16][17] Also, the similar observation was demonstrated by other papers that tracked fiducial markers on a set of lung cancer patients (measuring LR motion amplitude is less than both SI/AP amplitude), 24,25 because swallowing motion and respiratory motion yield similar displacement on each direction.…”

“…In this study and some previous reported studies, [13][14][15][16][17] H&N upper airway has been selected as the target to be tracked due to these reasons. First, the upper airway has highly deformable geometry that changes with either voluntary or involuntary H&N internal motion.…”

“…Such a manual step was similarly required in the study performed by Fricke et al on a 1.5-T MRI scanner, wherein a region of interest (ROI) containing nasopharynx and hypopharynx was first manually selected, and a κmeans clustering algorithm that classified the ROI using pixel intensity was subsequently performed to extract the upper airway volume. 14 In both studies, neither anatomical knowledge nor geometric prior were taken into account for target localization or boundary segmentation, thus highly demanding user intervention. These methods also require careful manual initialization in order to achieve acceptable results.…”

Upper airway changes in syndromic craniosynostosis patients following midface or monobloc advancement: Correlation between volume changes and respiratory outcome

“…Hypothetically, insufflation of air via the tracheal cannula might cause a collapse of the upper airway cranial of the tracheal cannula. This is supported by the findings of Fricke et al, who measured a significant decrease in volume of the naso-and hypopharyngeal airway in children with tracheostomy tubes after uncapping the tubes (Fricke et al, 2007). Conceivably, in these patients requiring insufflation during scanning, the compliance of the airway is higher due to breathing through the tube instead of the upper airway.…”

Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature

“…According to the medical literature, airway evaluation can be performed with magnetic resonance imaging (MRI) 1,8,9,71 , cine-MRI 28,34 , MDCT 4,13,22,25,26,30,33,42,[56][57][58]60,74 , endoscopy 38 and optical coherence tomography 10 . Although CBCT is inferior to MDCT in discriminating between different soft-tissue structures, Int.…”