Published ahead of print on October 11, 2002, doi:10.1164/rccm.200206-613OC
Am. J. Respir. Crit. Care Med., Volume 167, Number 1, January 2003, 65-70
A more recent version of this article appeared on January 1, 2003
Submitted on June 26, 2002
Accepted on October 3, 2002
Upper Airway Size Analysis using MRI in Children with Obstructive Sleep Apnea Syndrome
Raanan Arens1*, Joseph M McDonough2, Aaron M Corbin2, Nathania K Rubin2, Mary E Carroll2, Allan I Pack3, Jianguo Liu3, and Jayaram K Udupa3
1 Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA,
2 Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA,
3 Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA
* To whom correspondence should be addressed. E-mail: arens{at}email.chop.edu.
Detailed analysis of the upper airway has not been performed in children with obstructive sleep apnea. We used magnetic resonance imaging and automatic segmentation to delineated the upper airway in 20 children with obstructive sleep apnea and 20 controls (age 3.7±1.4 years vs. 3.9±1.7 years, respectively). We measured mean and minimum cross-sectional area, length, and volume of 1) the total airway, 2) regions along the adenoid, where adenoid and tonsils overlap, and tonsils, 3) ten segments at 10% increments along the airway. The mean cross-sectional area of the total airway of the obstructive sleep apnea group was significantly smaller in comparison to the control group, 28.1±12.6 mm2 vs. 47.1±18.2.5 mm2 (p<0.0005). Minimum cross-sectional area and airway volume were smaller in this group, 4.6±3.3 mm2 vs. 15.7±12.7 mm2 (p<0.0005), and 1129±515 mm3 vs. 1794±846 mm3 (p<0.005), respectively. Regional analysis suggested that the upper airway in children with obstructive sleep apnea is most restricted where adenoid and tonsils overlap. Segmental analysis demonstrated that the upper airway is restricted throughout the initial two thirds of its length and that the narrowing is not in a discrete region adjacent to either the adenoid or tonsils, but rather in a continuous fashion along both.
Key words: MRI, OSAS, Upper Airway
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