Recent Advances in Central Airway Imaging

doi:10.1378/chest.121.5.1651

Chest

Volume 121, Issue 5, May 2002, Pages 1651-1660

https://doi.org/10.1378/chest.121.5.1651 Get rights and content

The purpose of this article is to familiarize chest physicians with recent advances in airway imaging, with an emphasis on the emerging role of two-dimensional reformatted and three-dimensional CT reconstructed images in the assessment of central airway disorders.

Section snippets

Helical CT Scanning

The clinical introduction of helical CT scanning in 1991 dramatically improved the quality of CT images of the airway and other thoracic structures.^17,¹⁸ In comparison with conventional CT scanning, which uses a long scan time and acquires a series of individual axial slices with repeated breath holds, helical CT scanning has a short scan time and acquires a single, volumetric data set of the entire thorax during one breath hold (Fig 2).¹⁷ Importantly, helical CT scanning reduced respiratory

MRI

Although CT scanning generally is the preferred method of imaging the airway, there are two major instances in which MRI should be considered. First, because MRI does not involve ionizing radiation, it is the preferred modality for assessing paratracheal abnormalities in children (Fig 10).⁴⁶ Indeed, this technique is ideal for assessing paratracheal “rings and slings” that compress the airway. Second, because MRI does not require the use of an iodinated contrast agent, it is the preferred

Future Directions: Where Do We Go From Here?

In the near future, multidetector CT scanners and computerized reconstruction methods will become even faster and more widely accessible.²⁵ Additionally, viewing station advances will provide an ability to rapidly navigate between a variety of display methods, including 3-D internal and external renderings, in order to meet the needs of specific airway abnormalities and individual viewer preferences. With such advances, it is likely that 2-D reformation and 3-D reconstruction will eventually

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Diagnostic laryngoscopy and bronchoscopy (DLB) has been the traditional preoperative diagnostic modality for evaluating presence and severity of tracheobronchomalacia (TBM), and requires anesthesia. Alternatively, multidetector computed tomography (MDCT) is potentially a noninvasive modality that provides high-resolution, 3-dimensional (3D) imaging of the thorax providing preoperative guidance for pediatric surgeons. This study compares MDCT with intraoperative DLB in the assessment of TBM in symptomatic pediatric patients with esophageal atresia (EA).
Following IRB approval all pediatric patients (≤ 18 years) who had EA and who underwent an MDCT study as a preoperative evaluation of TBM prior to aortopexy were retrospectively reviewed. Patients with incomplete reports on intraoperative DLB or MDCT studies were excluded. Two pediatric radiologists independently evaluated all MDCT studies in a blinded fashion. On both DLB and MDCT studies, TBM was scored as present or absent in five anatomic segments: upper, middle, and lower trachea, as well as right and left main stem bronchi. Operative reports including DLB findings were reviewed and compared to findings from MDCT study using the chance corrected kappa (κ) coefficient. Diagnostic accuracy of dynamic MDCT for detecting TBM was determined by sensitivity and specificity, and interobserver agreement between two radiology reviewers was measured by the kappa statistic.
The final study population included 18 patients (8 males and 10 females) with ages ranging from 1 month to 11 years (median: 7 months). Their presenting clinical symptoms included apneic spells (n = 15, 83%) and failure to extubate (n = 3, 17%). The overall diagnostic accuracy of dynamic airway MDCT compared to DLB was 91% (82/90 possible segments for TBM) with excellent overall agreement across all 5 anatomic segments (κ = 0.82, p < 0.001). The agreements for upper, mid, lower trachea, and right and left trachea were 89% (κ = 0.73, p < 0.001), 94% (κ = 0.85, p < 0.001), 89% (κ = 0.76, p < 0.001), 94% (κ = 0.82, p < 0.001), and 89% (κ = 0.61, p = 0.005); respectively. Interobserver agreement between two radiologists was excellent (κ = 0.98, 95% confidence interval: 0.94–1.00, p < 0.001) with only 1 disagreement between two radiologists that was found for the left main bronchus. Fifteen (83.3%) of the patients clinically improved after the aortopexy.
MDCT with 3D imaging is a highly accurate and reliable preoperative noninvasive imaging modality for evaluating TBM in pediatric patients with EA providing anatomic information consistent with and complimentary to bronchoscopy.
Clinical pearls in pulmonary medicine (2013)
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The upper airway is generally defined as the air passage segment that extends between the naso- or oropharynx and the carina. The longest segment of the upper airway—the trachea—begins at the inferior portion of the larynx and extends to the branch point of the main carina. The trachea has the potential to be a “forgotten zone” in differential diagnoses, as pathological processes involving this portion may not receive prominent clinical consideration in disorders presenting with respiratory symptoms and signs. Unlike the oropharynx, this anatomical area is beyond visualization on routine inspection; unlike the mediastinum and lung fields, it is a potential “blind spot” on initial, plain radiographic examination of the chest. Nonetheless, the adult trachea is affected by a number of primary disorders and is also a target organ of a variety of systemic diseases. This review will focus on both primary and systemic diseases involving the adult trachea with specific attention to their clinical manifestations and diagnostic hallmarks.

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Chest

ReviewsRecent Advances in Central Airway Imaging

Section snippets

Helical CT Scanning

MRI

Future Directions: Where Do We Go From Here?

Eur J Radiol

Clin Chest Med

Eur J Radiol

Eur J Radiol

Chest

Chest

Chest

Lancet

Four multidetector-row helical CT: image quality and volume coverage speed

Radiology

A one year experience with the multislice helical CT

J Belge Radiol

Multi-slice CT spirals past single-slice CT in diagnostic efficacy

Diagn Imaging (San Franc)

Tracheobronchomalacia: dynamic airway evaluation with multidetector CT

AJR Am J Roentgenol

Perspective volume rendering of CT and MR images: applications for endoscopic imaging

Radiology

Tracheobronchial tree: assessment with volume rendering-technical aspects

Radiology

Volume rendering of the tracheobronchial tree: clinical evaluation of bronchographic images

Radiology

3D virtual endoscopy of the upper airway: optimization of the scan parameters in a cadaver phantom and clinical assessment

J Comput Assist Tomogr

Volumentric (helical/spiral) CT (VCT) of the airways

J Thorac Imaging

Three-dimensional imaging comes to the heartland, changing radiologic practice with its ability to guide interventions, examine complex pathologies, and assist in surgical planning

Diagn Imaging

Interactive three-dimensional volume rendering of spiral CT data: current applications in the thorax

Radiographics

Three-dimensional helical CT of the tracheobronchial tree: evaluation of imaging protocols and assessment of suspect stenoses with bronchoscopy correlation

AJR Am J Roentgenol

Normal tracheal during forced expiration: dynamic CT measurements

Radiology

Evaluation of tracheal collapsibility in patients with tracheomalacia using dynamic MR imaging during coughing

AJR Am J Roentgenol

Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation

Radiology

Reviews
Recent Advances in Central Airway Imaging