MULTIDETECTOR COMPUTED TOMOGRAPHY BASED THREE-DIMENSIONAL IMAGING OF AIRWAY: CAN WE REDUCE THE NEED OF CONVENTIONAL BRONCHOSCOPY IN PEDIATRIC POPULATION?

Tejeshwar Singh Jugpal, Anju Garg, Jyoti Kumar, Gulshan Rai Sethi

Abstract


Objective: To detect, localize and characterize intrinsic and extrinsic lesions of airway in the pediatric population using multi-detector computed tomography (MDCT) and to compare these findings with fiberoptic bronchoscopy (FB).

Material and methods: MDCT images were acquired in 35 children (aged 6 months to 16 years) with clinically suspected airway diseases. Computer generated multi-planar reformats (MPRs); minimum intensity projections (MinIPs) and virtual bronchoscopy images were reconstructed. The children subsequently underwent fiberoptic bronchoscopy. The findings were categorized into intraluminal obstruction, extra-luminal compression and dynamic airway compromise.

Result: A total of 29 lesions were detected in 28 children, whereas 7 children had normal airway. MDCT detected 18 intraluminal obstructive and 8 extra-luminal compressive lesions with a sensitivity and specificity of 100%. Additional synechiae was detected on MDCT distal to airway occlusion, which was not visualized on fiberoptic bronchoscopy. Out of the 3 dynamic airway lesions only one was detected on MDCT. The combined sensitivity, specificity, positive and negative predictive value of MDCT in detecting airway diseases were 93%, 100%, 100% and 77.8% respectively.

Conclusion: MDCT including virtual bronchoscopy is a rapid, accurate, non-invasive and reproducible method for evaluation and characterization of pediatric airway lesions. MDCT also visualizes distal lesions of airway, which can be easily missed on fiberoptic bronchoscopy due to a proximal occlusion. However, fiberoptic evaluation of airway is required to accurately detect dynamic airway lesions.


Keywords


tracheobronchial tree, pediatric airway, virtual bronchoscopy, bronchoscopy, 3-D airway imaging

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