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

Volume : VIII, Issue : X, October - 2019

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 onchoscopy (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 onchoscopy images were reconstructed. The children subsequently underwent fiberoptic onchoscopy. 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 onchoscopy. 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 onchoscopy 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 onchoscopy due to a proximal occlusion. However, fiberoptic evaluation of airway is required to accurately detect dynamic airway lesions.