Maryellen Sun MD, Presenter: Nothing to Disclose

Armin Ernst, Abstract Co-Author: Nothing to Disclose

Phillip Michael Boiselle MD, Abstract Co-Author: Nothing to Disclose

To evaluate the accuracy of MDCT of the central airways in comparison with bronchoscopy in the evaluation of benign and malignant central airway abnormalities.

All patients referred to the Interventional Pulmonology service at our institution routinely undergo MDCT of the central airways prior to bronchoscopy. A retrospective review was performed of all consecutive patients who underwent CT and bronchoscopy within this protocol during a 24-month period. Imaging was performed with an 8 channel multidetector row CT scanner in end-inspiratory and dynamic expiratory phases. MDCT imaging was interpreted by an experienced thoracic radiologist prior to bronchoscopy. Following bronchoscopy by an experienced interventional pulmonologist, CT and bronchoscopic findings were reviewed jointly for concordance, and the bronchoscopist determined whether MDCT could have prevented the need for diagnostic bronchoscopy.

The study population was comprised of 139 patients (76 female, 63 male, age range:16-88 years, mean age 55.5 years) referred for evaluation of malignant (n=40) and benign (n=99) airway abnormalities. Major airway abnormalities included tracheobronchomalacia (n=64), tracheobronchial stenosis (n=55), endoluminal lesions (n=42), and extrinsic compression (n=39), with some patients diagnosed with more than one major airway abnormality. CT findings were concordant with (89.2%) or superior to (3.6%) bronchoscopy in 129 (92.8%) of 139 cases. CT findings were discordant with bronchoscopic findings in 10 (7.2%) of 139 cases, resulting in a false negative CT in 6/10 cases and in a discrepancy of grading of the severity of an abnormality in 4/10 cases. Contributing technical factors were identified in 4/10 cases of discordance. When technically limited cases were excluded from analysis, CT was concordant with or superior to bronchoscopy in 129 (95.6%) of 135 cases. CT could have prevented diagnostic bronchoscopy in 71 (51.1%) of 139 cases.

MDCT of the central airways demonstrates excellent concordance with bronchoscopy and may preclude the need for diagnostic bronchoscopy in many cases. Attention to technical factors may further enhance the accuracy of CT.

Sun, M, Ernst, A, Boiselle, P, MDCT of the Central Airways: Comparison with Bronchoscopy in the Evaluation of Benign and Malignant Central Airway Abnormalities.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4408372.html