Feasibility of Assessing the Abnormal Pediatric Airway Using Rotational Optical Coherence Tomography

<h3>Background</h3> Methods currently used to assess and diagnose abnormalities of pediatric airways have several limitations: CT scans involve a risk of ionizing radiation and diagnostic dynamic bronchoscopies have high interobserver variability. Advanced diagnostic methods for evaluating the dynamic airway are needed to enable newer interventions (eg, airway stenting) in select children. The study objective was to investigate the feasibility of optical coherence tomography (OCT) as a measuring method that facilitates accurate, quantifiable, and real-time cross-sectional imaging of the airway. <h3>Research Question</h3> Is bronchoscopy-guided quantitative OCT of the lower pediatric airway a feasible method and does it increase diagnostic possibilities? <h3>Study Design and Methods</h3> We evaluated a series of 10 children with severe persistent respiratory symptoms with a clinical indication for diagnostic dynamic bronchoscopy (DDB). Feasibility of OCT was defined as the ability to visualize and quantify airway stenoses and dynamic airway collapse in the pediatric airway without procedural complications. Furthermore, the study included a porcine model to calculate the correction constant for the OCT measurements in air in comparison with contrast fluid. <h3>Results</h3> Nine children aged 0 to 14 years were included. In total, 34 airway segments were OCT scanned. Results showed that OCT is a feasible method for visualizing and quantifying stenoses of the lower pediatric airway by measuring the mean and minimum lumen areas. The correction constant of OCT in air was 1.3 (interquartile range, 1.29-1.31) in comparison with contrast. Visual assessment of the minimum lumen area stenosis by dynamic bronchoscopy significantly varies in comparison with OCT assessment (18.416%; 95% CI, 8.93-27.91; <i>P</i> = .0018). <h3>Interpretation</h3> OCT demonstrated feasibility of providing quantitative assessments of clinical manifestations including cross-sectional imaging in the pediatric airway. The correction constant for optimal quantification was calculated and provided the possibility for precise interpretation of OCT measurements. Further studies are needed to investigate safety, accuracy, and efficacy of OCT in the lower pediatric airway.