Role of imaging in diagnosis of congenital lung ahomalies in children

Abstract

Congenital lung anomalies include awide spectrum of anomalies involving parenchyma, bronchi, and vasculature and is considered an important cause of morbidity and mortality in infant and children. The reported incidence of congenital lung anomalies range from 1.2 :10,000 to 1: 35,000 pregnancies; however, these reports may be an underestimate of there true incidence. The radiologist role in the investigation of congenital lung anomalies has changed considerably in recent years. Advance in cross sectional techniques, howver, such as multidetector row CT and CT angiography , with improved MR imaging sequences now mean that invasive diagnostic angiography and bronchography are essentially obviated. Conservative management is increasingly used for children who would have been refered for open surgery in the past. Ultrasound usually forms the first imaging in the detection of congenital lung malformations that are identified during antenatal screening. Its benefits of accessibility, reproducibility and radiation safety further enables surveillance in the antenatal period. Plain radiographsusually forms the first imaging in the postnatal period. Contrast-enhanced volumetric (MDCT) multi-detector computerized tomography is established as the gold-standard imagingmodality in the radiographic characterisation of congenital lung malformations, Lesion characterisation with CT may influence antenatal counselling as well as surgical planning postnatally. The application of magnetic resonance imaging (MRI) has evolved, particularly in perinatal imaging, where it offers benefits of high contrast resolution and obviating ionising radiation to both mother and child, and enables quantification of congenital lesion size and volume of uninvolved lung that influence foetal prognostication, counselling and management. However, its longer scanning time necessitating general anaesthesia in most young children over 6 months of age (when a “feed and wrap” may be precluded), and its poor spatial resolution, particularly for assessment of lung parenchymal detail, ultimately confer significant disadvantages over CT in characterising most congenital lung malformations.