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Upper Airway Motion Depicted at Cine MR Imaging Performed during Sleep: Comparison between Young Patients with and Those without Obstructive Sleep Apnea¹

¹ From the Department of Radiology (L.F.D., K.A.C.), Division of Pulmonary Medicine (V.S., B.A.C., R.S.A.), and Department of Pediatrics (L.F.D., V.S., B.A.C., S.A.P., R.S.A.), Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039. Received March 14, 2002; revision requested May 2; final revision received October 3; accepted October 4. Address correspondence to L.F.D. (e-mail: lane.donnelly@cchmc.org).

View larger version (149K): [in a new window]   Figure 1. Six midline sagittal fast gradient-echo cine MR images (8.2/3.6, 80° flip angle, 8-mm section thickness) obtained over time in a 3-year-old boy without symptoms of obstructive sleep apnea show a lack of dynamic airway motion. The images were obtained continuously (labeled 1 through 6) and demonstrate no perceptible change in the diameter (ie, static patent) of the hypopharynx (arrows on image 1), nasopharynx (arrowheads on image 2), or oropharynx (arrow on image 3).

View larger version (154K): [in a new window]   Figure 2. Six midline sagittal fast gradient-echo cine MR images (8.2/3.6, 80° flip angle, 8-mm section thickness) obtained over time in an 11-year-old boy with obstructive sleep apnea show intermittent collapse of the hypopharynx secondary to obstruction by enlarged palatine tonsils. The images were obtained continuously (labeled 1 through 6) and demonstrate a severe change in the diameter of the hypopharynx (arrows on images 1 and 2), with collapse of the hypopharynx depicted on images 2, 4, and 6. Enlarged palatine tonsils (P on image 2) have intermittently moved inferiorly and into the midline (images 2, 4, and 6) and are obstructing the airway. The adenoid tonsils (A on images 1 and 2) also are enlarged.

View larger version (158K): [in a new window]   Figure 3. Six transverse fast gradient-echo cine MR images (8.2/3.6, 80° flip angle, 8-mm section thickness) obtained in a 5-year-old boy with obstructive sleep apnea, marked obesity, and Bardet Biedl syndrome show the dynamic motion of the hypopharynx to be greater in the left-to-right direction than in the anterior-to-posterior direction. The images were obtained continuously (from top left to bottom right) and demonstrate dynamic change in the size of the airway at the level of the hypopharynx. There is intermittent, nearly complete collapse of the hypopharynx. The change in left-to-right diameter (arrows) is much greater than the change in anterior-to-posterior diameter (arrowheads).