Tracheobronchial Anomalies and Stenoses: Detection with Low-Dose Multidetector CT with Virtual Tracheobronchoscopy—Comparison with Flexible Tracheobronchoscopy

Heyer, C. M.; Nuesslein, Thomas G.; Jung, David; Peters, Sören; Lemburg, Stefan P.; Rieger, Christian; Nicolas, Volkmar

doi:10.1148/radiol.2422060153

Cited by 84 publications

(53 citation statements)

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“…In a series including 45 children, the virtual bronchoscopy confirmed FB abnormalities in 33 patients out of 38 and failed to detect a trachea-bronchial malacia in five cases. The sensitivity and specificity of the virtual bronchoscopy were respectively 86.6% and 85.7% 26 .…”

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confidence: 93%

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

et al. 2016

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Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children's respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month -15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Tunisia. Afri Health Sci. 2016;16(1): 51-60. http://dx.doi.org/10.4314/ahs.v16i1.7 Introduction Pediatric pulmonology has experienced significant progress in recent decades in the understanding and management of respiratory diseases of children, becoming a specialty in itself. The development of diagnostic tools, including flexible bronchoscopy (FB), has contributed much to the development of this specialty.

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confidence: 93%

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

et al. 2016

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“…Virtual bronchoscopy performs well in comparison with fibreoptic bronchoscopy in detecting airway stenoses in adults [44,45] and children [46] but may overestimate the number of stenoses, particularly in segmental airways [44]. It is a useful tool for noninvasively grading stenotic lesions [43,44,47,48], and has several advantages over conventional bronchoscopy, allowing a view of the airway from below to ''look up'' at the vocal cords and provides views of airways beyond tight obstructing lesions in regions which bronchoscopes cannot access.…”

Section: Measuring Airway Dimensions From Ct Datamentioning

confidence: 99%

“…It is a useful tool for noninvasively grading stenotic lesions [43,44,47,48], and has several advantages over conventional bronchoscopy, allowing a view of the airway from below to ''look up'' at the vocal cords and provides views of airways beyond tight obstructing lesions in regions which bronchoscopes cannot access. Dynamic airway narrowing, as seen with bronchomalacia, may be missed on single-phase internal rendered scanning [46,49] and is more reliably detected by comparing paired inspiratory and expiratory scans or using cine-CT during dynamic forced expiratory manoeuvres [50][51][52][53].…”

Section: Measuring Airway Dimensions From Ct Datamentioning

confidence: 99%

Quantifying tracheobronchial tree dimensions: methods, limitations and emerging techniques

Williamson¹,

James²,

Phillips³

et al. 2009

European Respiratory Journal

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The ability to measure airway dimensions is important for clinicians, interventional bronchoscopists and researchers in order to accurately quantify structural abnormalities and track their changes over time or in response to treatment.Most quantitative airway measurements are based on X-ray computed tomography and, more recently, on multidetector computed tomography. Quantitative bronchoscopic techniques have also been developed, although these are less widely employed. Emerging techniques, including magnetic resonance imaging, endoscopic optical coherence tomography, endobronchial ultrasound and confocal endomicroscopy, provide new research tools with potential clinical applications.An understanding of issues related to the acquisition, processing and analysis of images, and how such issues impact on imaging the tracheobronchial tree, is essential in order to assess measurement accuracy and to make effective use of the newer methods. This article contributes to this understanding by providing a comprehensive review of current and emerging techniques for quantifying airway dimensions.KEYWORDS: Airway dimensions, confocal endomicroscopy, multidetector computed tomography, optical coherence tomography, videobronchoscopy A dvances over the past 20 yrs in medical imaging and bronchoscopy have heralded an era of unprecedented access to quantitative information on tracheobronchial structure and, increasingly, function. The expanding scope of technical advances challenges the ability of clinicians and researchers to keep abreast of recent developments and emerging techniques. Computed tomography (CT) and, to a lesser extent, bronchoscopy are the two imaging tools that have contributed most to our understanding of the airway in vivo and are used on a daily basis by clinicians in the management of airway diseases. Newer techniques, such as magnetic resonance imaging, optical coherence tomography, fibreoptic confocal endomicroscopy and endobronchial ultrasound, offer fresh insights into the way we view and quantify the airway.Over the coming years, the clinical applications of these newer techniques will be defined. As with endobronchial ultrasound, which has been adopted by interventional bronchoscopists in a little over a decade from its first reported use [1], it is likely that smoking-related lung diseases, such as bronchogenic cancer and chronic obstructive pulmonary disease (COPD), will drive the rapid development of new endoscopic imaging modalities and maintain the current pace of technical improvements of existing techniques, in particular CT. Initial applications of these techniques may focus on screening and surveillance of endobronchial malignancies and the use of real-time airway measurements during interventional procedures to deploy endobronchial stents. In these settings, accurate real-time quantitative imaging is advantageous.

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“…The greatest advantages over conventional tomography are in the increased speed in performing the examination and the possibility of thinner slices, with better spatial resolution for the 3D reconstruction. (13,14) However, the principal disadvantage of this procedure is the exposure to radiation, which can be minimized by avoiding the excessive use of tomography scans and reducing the tube current (in mA) to the minimum possible, and the need for the sedation of the patient. Typically, the minimal limit accepted for a good quality image is 30 mA and 80 kVp.…”

Section: Casementioning

confidence: 99%

Uso da broncoscopia virtual em pacientes pediátricos com suspeita de aspiração de corpo estranho

et al. 2009

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Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children, especially in those under three years of age. Preliminary radiological evaluation reveals normal chest X-rays in nearly 30% of such patients. Tomography-generated virtual bronchoscopy (VB) can facilitate the early diagnosis and rapid management of these cases. The definitive treatment is the removal of the foreign body by means of rigid bronchoscopy under general anesthesia. The objective of this study was to describe the use of VB in two patients with suspicion of FBA, as well as to review the literature regarding this topic. The two patients presented with sudden onset of respiratory symptoms and history of cough or choking with foods before these symptoms. Both patients were submitted to VB. In both cases, we detected an endobronchial foreign body, which was then removed by conventional rigid bronchoscopy in one of the cases. Only recently developed, VB is a noninvasive imaging method that has potential for use in detecting foreign bodies in the airways of children. In select cases, VB can indicate the exact location of the foreign body and even preclude the need to submit patients to rigid bronchoscopy in the absence of a foreign body.Keywords: Bronchoscopy; Pediatrics; Respiratory aspiration. ResumoA aspiração de corpo estranho (ACE) para o trato respiratório é um problema comum em pacientes pediátricos, em especial abaixo dos três anos de idade. Na avaliação radiológica inicial, cerca de 30% dos pacientes apresentam radiograma de tórax normal. A tomografia com broncoscopia virtual (BV) pode auxiliar no diagnóstico precoce desse quadro e seu pronto manejo. O tratamento definitivo se dá com a retirada do corpo estranho através de broncoscopia rígida e mediante anestesia geral. O objetivo deste trabalho foi descrever o uso da BV na abordagem de dois pacientes com suspeita de ACE e realizar uma revisão da literatura sobre este tópico. Os dois pacientes tiveram início súbito de sintomas respiratórios e relato de tosse ou engasgo com alimentos antecedendo o quadro. Os pacientes foram submetidos à BV, e foi detectada a presença de corpo estranho endobrônquico em ambos os casos, com remoção posterior por broncoscopia rígida convencional em um caso. A BV é um método não-invasivo recente e com potencial para detectar a presença de corpo estranho na via respiratória em crianças. Em casos selecionados, BV pode auxiliar na localização correta do corpo estranho e até mesmo evitar o procedimento de broncoscopia rígida na ausência de corpo estranho.

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Tracheobronchial Anomalies and Stenoses: Detection with Low-Dose Multidetector CT with Virtual Tracheobronchoscopy—Comparison with Flexible Tracheobronchoscopy

Abstract: Multidetector CT with VT with a low-dose protocol had high sensitivity and specificity for depiction of tracheobronchial narrowings and/or anomalies. However, tracheal narrowing due to tracheobronchomalacia was difficult to diagnose at single-phase multidetector CT with VT.

Cited by 84 publications

References 30 publications

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

Quantifying tracheobronchial tree dimensions: methods, limitations and emerging techniques

Uso da broncoscopia virtual em pacientes pediátricos com suspeita de aspiração de corpo estranho

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