Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2023 Apr;168(4):848-855. doi: 10.1177/01945998221097659. Epub 2023 Feb 5.
To compare findings of same-day cine magnetic resonance imaging (MRI) and drug-induced sleep endoscopy (DISE) and examine how each technique uniquely contributes to the evaluation of persistent obstructive sleep apnea following adenotonsillectomy.
Retrospective cohort study.
Quaternary care center.
Chart review was performed for consecutive patients who underwent same-day cine MRI and DISE between 2015 and 2020. Descriptive statistics are reported, and Cohen kappa coefficients were calculated to evaluate the agreement between cine MRI and DISE for obstruction at the adenoids, lingual tonsils, and tongue base.
There were 137 patients, the mean age was 10.4 years (95% CI, 3.2-16.7), and 62.8% were male. The most common sites of obstruction on DISE were the tongue base (86.9%), velum (78.7%), epiglottis (74.5%), inferior turbinate (68.6%), and lingual tonsil (61.3%). The most common sites of obstruction on cine MRI were the hypopharynx (56.3%), tongue base (44.8%), lingual tonsil (38.0%), and macroglossia (37.6%). There was moderate agreement for adenoid hypertrophy (κ = 0.53) and poor agreement for lingual tonsil hypertrophy (κ = 0.15) and tongue base obstruction (κ = 0.09). DISE identified more instances of multilevel obstruction when compared with cine MRI (94.9% vs 48.2%).
DISE offered a better examination of nasal and supraglottic obstruction and is sensitive to partial vs complete collapse, while cine MRI offered better soft tissue resolution for lymphoid tissue hypertrophy and provided a global view of primary and secondary airway obstruction. Cine MRI and DISE are complementary modalities in the evaluation of children with persistent obstructive sleep apnea.
比较同一天的电影磁共振成像（MRI）和药物诱导睡眠内窥镜检查（DISE）的结果，并研究每种技术如何独特地评估腺样体扁桃体切除术后持续性阻塞性睡眠呼吸暂停。
回顾性队列研究。
四级保健中心。
对 2015 年至 2020 年间接受同一天电影 MRI 和 DISE 的连续患者进行了图表审查。报告描述性统计数据，并计算 Cohen kappa 系数，以评估电影 MRI 和 DISE 在评估腺样体、舌扁桃体和舌基底阻塞方面的一致性。
共有 137 名患者，平均年龄为 10.4 岁（95%CI，3.2-16.7），62.8%为男性。DISE 最常见的阻塞部位是舌基底（86.9%）、软腭（78.7%）、会厌（74.5%）、下鼻甲（68.6%）和舌扁桃体（61.3%）。电影 MRI 最常见的阻塞部位是下咽（56.3%）、舌基底（44.8%）、舌扁桃体（38.0%）和巨舌（37.6%）。腺样体肥大的一致性为中度（κ=0.53），舌扁桃体肥大（κ=0.15）和舌基底阻塞（κ=0.09）的一致性差。与电影 MRI 相比，DISE 更能发现多水平阻塞（94.9% vs 48.2%）。
DISE 更能检查鼻腔和口咽部阻塞，对部分与完全塌陷敏感，而电影 MRI 对淋巴组织肥大具有更好的软组织分辨率，并提供原发性和继发性气道阻塞的整体视图。电影 MRI 和 DISE 是评估持续性阻塞性睡眠呼吸暂停儿童的互补方法。
