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Correlation on Cine MR Imaging of Size of Adenoid and Palatine Tonsils with Degree of Upper Airway Motion in Asymptomatic Sedated Children

¹ Department of Radiology, Children's Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
² Department of Pediatrics, Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039.

OBJECTIVE. The objective of this study was to use MR fluoroscopy to evaluate variations in size of the adenoid and palatine tonsils and the relationship between tonsil enlargement and airway motion dynamics in asymptomatic children during sleep.

SUBJECTS AND METHODS. We performed sagittal midline cine MR imaging (fast gradient-echo series: TR/TE, 8.2/3.6 sec; flip angle, 80°; slice thickness, 8 mm; 128 consecutive images; imaging time, 2 min; displayed in cine mode) in children referred for MR imaging of the brain who required sedation. The largest transverse diameter of the adenoids was recorded. A subjective impression was made as to whether the adenoids were enlarged or normal in size. Palatine tonsils were considered enlarged when a soft-tissue mass was identified on the midline cine images, and maximum diameter was recorded. Enlarged and nonenlarged adenoid and palatine tonsil groups were compared using motion parameters (chi-square or Fisher's exact test): mouth position (opened or closed); vertical motion (present, absent); nasopharyngeal, oropharyngeal, and hypopharyngeal motion (static patent, dynamic patent, intermittent collapsed, or static collapsed, and greatest change in size).

RESULTS. We studied 148 subjects who had a mean age of 3.4 years. The adenoid tonsils were considered enlarged in 64 patients (43%), and the palatine tonsils were considered enlarged in 29 patients (20%). The mean size of the enlarged adenoid tonsils was 11.6 mm and of the nonenlarged adenoid tonsils was 6.2 mm. Enlarged adenoids correlated with the open mouth position (p = 0.0242) and increased dynamic motion of the oropharynx (p = 0.0413). A trend was also seen for increased dynamic motion of the nasopharynx (p = 0.0723). Enlarged palatine tonsils correlated with an increased frequency of dynamic motion of the oropharynx (p = 0.0006) and the nasopharynx (p = 0.0033) and a trend for increased frequency of the open mouth position (p = 0.0692).

CONCLUSION. Large adenoid and palatine tonsil size affects breathing dynamics of the upper airway even in asymptomatic children.

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