Chest MRI Effective in Screening Children for Lung Disease

Tuesday, Nov. 27, 2018

Pediatric chest MRI provides high image quality and can be an effective technique for screening large groups of children for lung and airway diseases, such as asthma, according to research presented Monday.



According to presenter Alice Pittaro, MD, Erasmus Medical Center, Rotterdam, Netherlands, pediatric chest MRI is a relatively new technique that is slowly replacing CT in pediatric thoracic imaging.

"But it remains challenging in a clinical setting," she said. "Only large centers have built up enough experience to routinely use this technique. The Erasmus Medical Center is one of the leading centers in thoracic MRI in Europe, having used this technique in the clinic since 2009."

In this study, two end-inspiratory and end-expiratory breath-hold chest MRI scans were performed on each of 3,150 healthy children (81 of whom were excluded from final analysis because of missing data). Image quality was assessed using a 5-point scale, from poor (score 1) to excellent (score 5). Incidental findings were classified as clinically relevant or clinically non-relevant. 

Dr. Pittaro and her colleagues determined that the median image quality was good-to-excellent (4.5 on the 5-point scale). In addition, they found 1,400 incidental findings (64 relevant and 1,336 non-relevant) in 1,182 of the children in the study.

The most common potentially relevant incidental findings were severe trapped-air (>25 percent lung lobe volume), severe tracheomalacia collapse (>70 percent), and large atelectasis/consolidation (>10 percent of lobe volume).

The most common clinically non-relevant incidental findings included mild trapped air, atelectasis, mild tracheomalacia, and small parenchymal nodules.

Technique May Help Predict Asthma

"This was a unique opportunity to screen a large group of healthy children for possible determinants of lung and airways diseases — asthma, in particular," Dr. Pittaro said. "The clinical importance of the study is that chest incidental findings are quite common in the pediatric population and need to be correlated to the clinical conditions of the children."

Specifically, she pointed out that radiologists should be aware that more than one-third of asymptomatic children may have a clinically non-relevant incidental finding. Furthermore, she said, small areas of trapped-air or limited consolidations are quite common in healthy children and likely to have no clinical relevance.

However, while relevant thoracic incidental findings were rare in the study population, the researchers did find that more than half of the clinically relevant incidental findings were severe trapped-air.

"At this point we cannot say if these children are potential asthmatic children, because they are symptom free," Dr. Pittaro said. "However, we will follow this cohort until 18 years of age, so we will have the ability to see who will develop asthma and who will not, and to compare the amount of air trapping seen at this time point. In this way, we will determine the real prevalence of air trapping in children with asthma."