Liszewski Mark C, Ciet Pierluigi, Winant Abbey J, Lee Edward Y
Departments of Radiology and Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
Departments of Radiology and Nuclear Medicine.
J Thorac Imaging. 2024 Jan 1;39(1):57-66. doi: 10.1097/RTI.0000000000000707. Epub 2023 Mar 31.
Disorders of the lungs and airways are among the most common indications for diagnostic imaging in infants and children. Traditionally, chest radiograph has been the first-line imaging test for detecting these disorders and when cross-sectional imaging is necessary, computed tomography (CT) has typically been the next step. However, due to concerns about the potentially harmful effects of ionizing radiation, pediatric imaging in general has begun to shift away from CT toward magnetic resonance imaging (MRI) as a preferred modality. Several unique technical challenges of chest MRI, including motion artifact from respiratory and cardiac motion as well as low signal-to-noise ratios secondary to relatively low proton density in the lung have slowed this shift in thoracic imaging. However, technical advances in MRI in recent years, including developments in non-Cartesian MRI data sampling methods such as radial, spiral, and PROPELLER imaging and the development of ultrashort TE and zero TE sequences that render CT-like high-quality imaging with minimal motion artifact have allowed for a shift to MRI for evaluation of lung and large airways in centers with specialized expertise. This article presents a practical approach for radiologists in current practice to begin to consider MRI for evaluation of the pediatric lung and large airways and begin to implement it in their practices. The current role for MRI in the evaluation of disorders of the pediatric lung and large airways is reviewed, and example cases are presented. Challenges for MRI of the lung and large airways in children are discussed, practical tips for patient preparation including sedation are described, and imaging techniques suitable for current clinical practice are presented.
肺部和气道疾病是婴幼儿和儿童诊断性影像学检查最常见的指征之一。传统上，胸部X线片一直是检测这些疾病的一线影像学检查方法，当需要进行横断面成像时，计算机断层扫描（CT）通常是下一步检查手段。然而，由于担心电离辐射的潜在有害影响，儿科影像学总体上已开始从CT转向磁共振成像（MRI），将其作为首选检查方式。胸部MRI存在一些独特的技术挑战，包括呼吸和心脏运动产生的运动伪影，以及由于肺部质子密度相对较低导致的低信噪比，这些因素减缓了胸部影像学检查方式的这种转变。然而，近年来MRI技术的进步，包括非笛卡尔MRI数据采样方法（如径向、螺旋和螺旋桨成像）的发展，以及超短TE和零TE序列的开发，这些序列能够在运动伪影最小的情况下实现类似CT的高质量成像，使得在具备专业技术的中心可以转向使用MRI来评估肺部和大气道。本文为放射科医生在当前实践中开始考虑使用MRI评估小儿肺部和大气道并将其应用于实际工作提供了一种实用方法。文中回顾了MRI在小儿肺部和大气道疾病评估中的当前作用，并展示了示例病例。讨论了儿童肺部和大气道MRI检查面临的挑战，描述了包括镇静在内的患者准备实用技巧，并介绍了适用于当前临床实践的成像技术。
