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QUAD #26 - Use of Ultrashort Echo-Time MRI to Measure Tracheomalacia in Neonates with Esophageal Atresia with Dr. Douglas von Allmen
With CCHMC Pediatric Surgery
Chapter 1 of 4 · Fundamentals
UTE MRI intro
Introduction to ultrashort echo-time MRI for tracheomalacia evaluation
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What the experts said
Tracheomalacia is weakening of the airway wall, which collapses the airway in lumen during respiration.
The gold standard to diagnose tracheomalacia is bronchoscopy.
Flexible bronchoscopy has variations in sedation and breathing vigor which can affect the static imaging.
Ultra short echo time MRI uses motion tracking to evaluate tracheomalacia and is less invasive and doesn't use ionizing radiation.
UTE MRI can be done in neonates without any sedation.
Faulty division of the foregut suggests changes in the posterior membrane of the trachea that may make it more susceptible to being malacic.
Long gap esophageal atresia patients have more tracheomalacia than short gap esophageal atresia patients.
The trachea was divided into thirds to look at what was going on in different parts of the airway.
Tracheal eccentricity refers to how off-center the trachea's position is from where it should be, with smaller values representing a more eccentric airway.
The period of expiration is when you see the most collapse during tracheomalacia.
The minimum value during the period of expiration was used in each third of the trachea for measurement.
The retrospective study included 26 patients with esophageal atresia who had preoperative studies prior to their TEF/EA repair.
A subset of patients had post-op imaging after their repair and ligation.
Short gap was defined as two centimeters or less between the proximal and distal pouch.
Most of the patients had a distal tracheoesophageal fistula.
The majority of the patients had a short gap esophageal atresia.
A portion of these patients required at least one steroid or one pneumonia course per year afterwards.
Along all levels of the trachea, the long gap esophageal atresia patients had a more eccentric trachea compared to short gap patients.
When looking at bronchoscopy results, there wasn't a lot of difference in terms of the patients that had significant collapse greater than 75%.
In the upper third of the trachea, the eccentricity was significantly improved after the repair.
In the distal trachea, the eccentricity got significantly worse after repair.
The middle portion of the trachea remained unchanged after repair.
Upper trachea improvement is probably because there is a dilated esophageal pouch, and once you decompress that, it also relieves the compression on the upper trachea.
Changes in the lower trachea are suspected to be due to mobilization of the distal segment and ligation of the TEF.
Despite having a significantly longer NICU stay, long gap esophageal atresia patients were more likely to have respiratory-related admissions.
Long gap esophageal atresia patients have a higher risk of significant tracheomalacia.
Long gap EA patients had a more eccentric or flattened airway along the length of the airway.
After repair, the eccentricity worsened in the distal third of the trachea.
The distal third is an important segment to consider, even if it doesn't look severe when you do your first bronchoscopy.
Ultra-short echo-time MRI effectively evaluates the severity of tracheomalacia without intubation, sedation, or radiation in neonates.