The Role of Multidetector CT Virtual Bronchoscopy in Assessment of Patients with Laryngotracheal Stenosis

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Background: Proper assessment of the site, degree and length of laryngotracheal stenosis is essential for proper selection of the procedure and helps in anticipating future prognosis. Virtual bronchoscopy (VB) is a novel CT-based imaging technique that allows a three-dimensional (3D) evaluation of the airway. Objective:Is to assess the utility of CT virtual bronchoscopy in assessment of laryngotracheal stenosis. Patients and methods: A case series study was conducted on 26 patients diagnosed as laryngotracheal stenosis with age more than 3 years old. All patients were assessed by history, general examination and routine ear, nose and throat examination. Laryngeal examination was performed using flexible naso-pharyngo-laryngoscopy under local anesthesia. Computed tomography scanning with axial, mutiplanner reconstruction and virtual bronchoscopy images was performed for all patients using multidetector scanners to define the site, grade and length of stenotic segment. All patients were assessed by rigid bronchoscopy under general anesthesia to confirm the results of virtual bronchoscopy regarding site, grade and length of stenotic segment. Sensitivity, specificity and diagnostic accuracy were calculated for virtual bronchoscopy. Results: The sensitivity, specificity and diagnostic accuracy of virtual bronchoscopy in localizing the site of stenosis were 100% for all. The sensitivity, specificity and diagnostic accuracy of virtual bronchoscopy in grading the stenosis were 85.3%, 94.5% and 92% respectively. The sensitivity, specificity and diagnostic accuracy of virtual bronchoscopy in measuring the length of stenosis were 92.3%, 94.3% and 92% respectively. Conclusion:CT Virtual endoscopy is a highly accurate method in detection of the presence of laryngotracheal stenosis. However, it needs confirmation by rigid bronchoscopy for measurement of the grade and length of stenosis.