MDCT of the Central Airways

Abstract

To evaluate the accuracy of multidetector row computed tomography (MDCT) compared with bronchoscopy in the assessment of airway complications related to endotracheal and tracheostomy tubes. A review was performed of all consecutive patients undergoing computed tomography (CT) and bronchoscopy for symptomatic complications of endotracheal or tracheostomy tubes during an 18-month period. MDCT imaging was performed according to a standard protocol and interpreted by an experienced thoracic radiologist before bronchoscopy. After bronchoscopy by an experienced interventional pulmonologist, CT and bronchoscopic findings were reviewed jointly, and the accuracy of CT was determined using bronchoscopy as the "gold standard." The study population was comprised of 32 patients (range: 26 to 88 y, mean 55.6) with a total of 47 airway complications: tracheal stenosis (n=25), tracheomalacia (n=8), tracheal granulation tissue (n=8), tracheal cartilage fracture (n=4), tracheal perforation (n=1), and tracheostomy tube disruption (n=1). CT accurately diagnosed 42 of 47 airway complications (sensitivity 89.4%, specificity 95.2%, positive predictive value 85.7%, negative predictive value 96.5%). False negative findings at CT occurred in 5 (11.1%) of 47 cases. Contributing technical factors were identified in 3 (60.0%) of 5 false-negative cases, including the presence of tracheostomy tube during imaging and patient inability to complete the CT protocol. MDCT of the central airways is highly accurate for detecting symptomatic airway complications of endotracheal and tracheostomy tubes, particularly when technical limitations to the performance of CT are minimized.