Abstract
BackgroundWe evaluated the ability of 3D-CT and virtual bronchoscopy to estimate trachea stenosis in comparison to conventional axial CT and fiberoptic bronchoscopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures.MethodsSpiral CT was performed in 16 patients with suspected tracheal stenoses and in 5 normal subjects. Tracheal stenoses due to an endoluminal neoplasm were detected in 13 patients, whilst post-intubation tracheal stricture was observed in the other 3 patients. Multiplanar reformatting (MPR), volume rendering techniques (VRT) and virtual endoscopy (VE) for trachea evaluation were applied and findings were compared to axial CT and fiberoptic bronchoscopy. The accuracy of the procedure in describing the localization and degree of stenosis was tested by two radiologists in a blinded controlled trial.ResultsThe imaging modalities tested showed the same stenoses as the ones detected by flexible bronchoscopy and achieved accurate and non-invasive morphological characterization of the strictures, as well as additional information about the extraluminal extent of the disease. No statistically significant difference was observed between the bronchoscopic findings and the results of axial CT estimations (P = 1.0). No statistically significant differences were observed between bronchoscopic findings and the MPR, VRT and VE image evaluations (P = 0.705, 0.414 and 0.414 respectively).ConclusionCT and computed generated images may provide a high fidelity, noninvasive and reproducible evaluation of the trachea compared to bronchoscopy. They may play a role in assessment of airway patency distal to high-grade stenoses, and represent a reliable alternative method for patients not amenable to conventional bronchoscopy.
Highlights
We evaluated the ability of 3D-CT and virtual bronchoscopy to estimate trachea stenosis in comparison to conventional axial CT and fiberoptic bronchoscopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures
A variety of computer processing algorithms can be applied in CT acquired data such as: multiplanar reformatting (MPR), shaded surface display (SSD), maximum or minimum intensity projection (MIP), volume rendering techniques (VRT) and more recently virtual endoscopy (VE) [5,6,7,8,9,10,11,12]
Axial CT-slices A total of 21 tracheal stenoses were depicted during fiberoptic bronchoscopy in all 21 subjects (16 patients with trachea narrowing and 5 normal controls)
Summary
We evaluated the ability of 3D-CT and virtual bronchoscopy to estimate trachea stenosis in comparison to conventional axial CT and fiberoptic bronchoscopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures. Bronchoscopy has potentially hazardous complications in the severely ill patients (profound oxygen desaturation in hypoxemic patients, tachycardia, cardiac arrhythmias, endoscopy-induced inflammation of the immunocompromised), and some technical limitations such as inability to evaluate airway calibre and morphology beyond a high-grade stenosis of the bronchial lumen. It is not an examination well-tolerated by all patients [1,2,3,4]. The acquired images provide detailed information regarding the tracheobronchial tree and its pathology. A variety of computer processing algorithms can be applied in CT acquired data such as: multiplanar reformatting (MPR), shaded surface display (SSD), maximum or minimum intensity projection (MIP), volume rendering techniques (VRT) and more recently virtual endoscopy (VE) [5,6,7,8,9,10,11,12]
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