Korean J Radiol.  2018 Feb;19(1):111-118. 10.3348/kjr.2018.19.1.111.

Four-Dimensional CT of the Diaphragm in Children: Initial Experience

• Goo HW

• KMID: 2425116
• DOI: http://doi.org/10.3348/kjr.2018.19.1.111

Abstract

OBJECTIVE
To evaluate the technical feasibility of four-dimensional (4D) CT for the functional evaluation of the pediatric diaphragm.
MATERIALS AND METHODS
In 22 consecutive children (median age 3.5 months, age range 3 days-3 years), 4D CT was performed to assess diaphragm motion. Diaphragm abnormalities were qualitatively evaluated and diaphragm motion was quantitatively measured on 4D CT. Lung density changes between peak inspiration and expiration were measured in the basal lung parenchyma. The diaphragm motions and lung density changes measured on 4D CT were compared between various diaphragm conditions. In 11 of the 22 children, chest sonography was available for comparison.
RESULTS
Four-dimensional CT demonstrated normal diaphragm (n = 8), paralysis (n = 10), eventration (n = 3), and diffusely decreased motion (n = 1). Chest sonography demonstrated normal diaphragm (n = 2), paralysis (n = 6), eventration (n = 2), and right pleural effusion (n = 1). The sonographic findings were concordant with the 4D CT findings in 90.9% (10/11) of the patients. In diaphragm paralysis, the affected diaphragm motion was significantly decreased compared with the contralateral normal diaphragm motion (−1.1 ± 2.2 mm vs. 7.6 ± 3.8 mm, p = 0.005). The normal diaphragms showed significantly greater motion than the paralyzed diaphragms (4.5 ± 2.1 mm vs. −1.1 ± 2.2 mm, p < 0.0001), while the normal diaphragm motion was significantly smaller than the motion of the contralateral normal diaphragm in paralysis (4.5 ± 2.1 mm vs. 7.6 ± 3.8 mm, p = 0.01). Basal lung density change of the affected side was significantly smaller than that of the contralateral side in diaphragm paralysis (89 ± 73 Hounsfield units [HU] vs. 180 ± 71 HU, p = 0.03), while no significant differences were found between the normal diaphragms and the paralyzed diaphragms (136 ± 66 HU vs. 89 ± 73 HU, p = 0.1) or between the normal diaphragms and the contralateral normal diaphragms in paralysis (136 ± 66 HU vs. 180 ± 71 HU, p = 0.1).
CONCLUSION
The functional evaluation of the pediatric diaphragm is feasible with 4D CT in select children.

Keyword

4D CT; Diaphragm; Child; Functional CT evaluation; Diaphragm paralysis; Diaphragm eventration; Chest sonography

MeSH Terms

Child*
Diaphragm*
Diaphragmatic Eventration
Four-Dimensional Computed Tomography*
Humans
Lung
Paralysis
Pleural Effusion
Thorax
Ultrasonography