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Table 1 Comparison of advantages and disadvantages of various imaging approaches in young infants with achondroplasia
| Study: | Advantages | Disadvantages | Comments |
|---|---|---|---|
| CT | Usually not requiring sedation | Poor delineation of neural structures | |
| Only study method for which there are diagnosis-specific standards (FM size) [122] | Substantial radiation exposure, particularly if not performed in children’s facility | ||
| Only study method for which prospective assessment of value in ascertaining risk is available [8] | In substantial minority, along with results of other non-radiologic studies, will lead to MRI subsequently | In our experience, about 20% of those following protocol including CT will go on to MRI | |
| MRI | Excellent delineation of neural structures | Virtually always requires sedation or anesthesia | Because of respiratory concerns present in most infants with achondroplasia, anesthesia is usually needed |
| No radiation exposure | No diagnosis-specific standards | ||
| Substantial risk of over-reliance in determining if surgery is needed | Although not prevalent in our center, there are many anecdotes of electing to have decompressive surgery based on MRI craniocervical features alone, which we would judge to be non-actionable without other indications | ||
| Fast MRI | Fair delineation of neural structures | Detail may be insufficient for decision making | |
| No radiation exposure | No diagnosis-specific standards | ||
| No sedation or anesthesia needed | In substantial minority will lead to full MRI before deciding if surgery is needed | At current level of detail, findings on fast MRI will always need to be confirmed by routine MRI if surgery is contemplated | |
| No routine imaging | No sedation or anesthesia | Under-ascertainment of those needing decompression | This is, in my opinion, an unacceptable risk |
| No radiation exposure | Ignores what prospective and reasonably well controlled trial data as are available to prevent further neurologic injury or sudden death. |
