Studies in the adult population show that quantification of vocal cord function is possible using dynamic MRI. The narrow and noisy environment of an MRI scanner, together with the need for a subject to lie still during the MRI examination often requires the use of anesthetics for laryngeal MRI investigations in children younger than 5 years.
With the development of faster scanning protocols the need for anesthetics is likely to be reduced.
Likewise, dynamic laryngeal MRI techniques require full cooperation without the influence of anesthetics. MRI is a promising modality for the evaluation of pediatric laryngeal diseases Table 3. Most of the MRI studies on the anatomy of the pediatric larynx were conducted before , so with the recent technological advancements of MRI, image quality has definitely improved. The most recent studies focused on tissue characterization and on the effect of anesthesia in the larynx.
Studies using MRI as a diagnostic imaging modality and longitudinal studies are scarce. In addition, although dynamic imaging of the vocal cords has been proven feasible in the adult population, implementation in the pediatric population is still lacking. Clinical studies on the technical use of MRI in the spectrum of pediatric laryngeal diseases, such as laryngeal stenosis and vocal cord dysfunction, are lacking. Further research should be conducted to explore these options. We would like to acknowledge W. Bramer, from the Erasmus MC—medical library, for his assistance in the literature search.
There is no funding to report for this study. Elders, Dr S. Hermelijn, Dr B. Pullens, and P. Wielopolski report no disclosures. Prof Dr H. Tiddens reports to be involved in an industry symposium on cystic fibrosis with Roche, to be involved in lectures and the advisory board of Novartis.
He has obtained grants from Vertex, Gilead, and Chiesi; outside this submitted work. Ciet reports to have obtained personal fees from Vertex, outside this submitted work.
Additional supporting information may be found online in the Supporting Information section at the end of the article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries other than missing content should be directed to the corresponding author for the article. Volume 54 , Issue 4. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.
Pediatric Pulmonology Volume 54, Issue 4. Bernadette B. Sergei M. Pjotr A. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Background Magnetic Resonance Imaging MRI techniques to image the larynx have evolved rapidly into a promising and safe imaging modality, without need for sedation or ionizing radiation.
Methods A systematic search was conducted to identify all morphological and diagnostic studies in which MRI was used to image the pediatric larynx, laryngeal disease, or vocal cords. Results Fourteen articles were included: three studies on anatomical imaging of the larynx, two studies on Diffusion Weighted Imaging, four studies on vocal cord imaging and five studies on the effect of anaesthesiology on the pediatric larynx.
Conclusion MRI is promising to evaluate the pediatric larynx, but studies using MRI as diagnostic imaging modality are scarce. Figure 1 Open in figure viewer PowerPoint.
Figure 3 Open in figure viewer PowerPoint. Advantages Disadvantages No sedation needed Inferior spatial resolution to CT Free of ionizing radiation Long scanning time compared to CT Excellent soft tissue contrast Differentiation between malignant and inflammatory lesions can be challenging Good visualization of vascular structures Bony involvement can be challenging Dynamic imaging possible.
Supporting Information Additional supporting information may be found online in the Supporting Information section at the end of the article. Filename Description ppulsupSuppData-S1. Glottic stenosis. Semin Pediatr Surg. Wiley Online Library Google Scholar.
Crossref PubMed Google Scholar. Crossref Google Scholar. Google Scholar. Volume 54 , Issue 4 April Pages Figures References Related Information.
Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure. Email or Customer ID. The lesion typically appears as a well-defined mass in the posterior or lateral portion of the subglottic airway Fig. Additional hemangiomas may occur on the skin or elsewhere in the body.
Subglottic hemangioma. Lateral view shows a soft tissue mass arrows in the posterior portion of the subglottic airway.
Squamous papillomas, the most frequent laryngeal tumors in children, have also been reported in adults. Generally single or multiple intraluminal soft tissue nodules are seen in the glottis or in the tracheal air column Fig. Because papillomas may extend to the bronchial tree or pulmonary parenchyma, chest CT is extremely important in defining the extent of disease.
Localized areas of atelectasis, air trapping, or pneumonia have been reported. Papillomas also may appear as well-defined discrete pulmonary nodules that eventually cavitate, forming multiple thin-walled cystic lesions. Laryngotracheal papillomatosis. Oblique view from a bronchogram shows multiple nodules arrows of varying sizes in the glottic and subglottic airway.
These lesions may present on laryngoscopy as soft, localized bulges of the aryepiglottic fold and may be mistaken clinically for submucosal neoplasms. Most cases are a combination of external and internal lesions and are referred to as mixed. Regardless of position, laryngoceles are usually visualized as sharply defined air-containing structures on imaging Fig.
Laryngeal mucocele is a fluid-filled laryngocele caused by obstruction of the ostium of laryngeal saccule and may appear as a soft tissue mass. Mixed laryngocele. Frontal view shows the large internal I and external E components of the laryngocele with compression of the supraglottic airway arrows. CT can be helpful in showing fluid-containing and air-containing laryngoceles Figs. However, its location and smooth surface in conjunction with a healthy mucosa on laryngoscopy should suggest a laryngocele.
CT may also help show the external component of a laryngocele that is not apparent on physical examination. An enhancing wall usually indicates infection. The endolaryngeal origin of this lesion differentiates it from a lateral thyroglossal duct cyst.
Internal laryngocele. Computed tomography shows the air-filled laryngocele L filling the right paraglottic space and compressing the laryngeal vestibule V. The hyoid bone H is also seen.
Bilateral mixed laryngoceles. A, Computed tomography CT shows a fluid-filled, dumbbell-shaped cyst with intralaryngeal and extralaryngeal components on the left. Smaller air-filled laryngocele is seen on the right. B , Reformatted coronal CT shows both laryngoceles herniating through the thyrohyoid membrane. The hyoid bone H and thyroid cartilage T are also seen. Congenital cysts of the larynx are rare causes of respiratory obstruction in infants. They most commonly arise in the region of the epiglottis or aryepiglottic fold.
Plain-film examination of the airway will disclose a soft tissue mass of varying size, encroaching on and displacing the healthy airway. Nearly all mucosal tumors are diagnosed by direct inspection and biopsy; imaging provides crucial information about involvement of deep structures such as the paraglottic space, cartilage, and lymph nodes. CT is a proven imaging technique for evaluating patients with laryngeal carcinoma.