Spiral CT virtual bronchoscopy with multiplanar reformatting in the evaluation of post-intubation tracheal stenosis: comparison between endoscopic, radiological and surgical findings

Mohamed Shehata Taha, Badr Eldin Mostafa, Marwa Fahmy, Maha Khaled A Ghaffar, Enas Abdel Ghany
European Archives of Oto-rhino-laryngology 2009, 266 (6): 863-6
We evaluated the usefulness and accuracy of spiral CT in detection and assessment of post-intubation tracheal stenosis. Fourteen patients with post intubation stenosis underwent evaluation of their airway by spiral CT scan with multiplanar reformatting (MPR) and virtual endoscopy (VE) and conventional rigid bronchoscopy, and telescopy (RB). The following parameters were assessed: involvement of the subglottic larynx, site, number, and degree of the stenosis. The results were compared with the intra-operative findings. The detection rate for tracheal stenotic lesions was 94% by CT and 88% by rigid bronchoscopy. The sensitivity and specificity of both CT scan and bronchoscopy in the detection of subglottic stenosis was 100%. The preoperative assessment of the length of stenosis was accurate in 14 (87%) of the 16 stenotic segments detected by CT and in 11 (73%) of the 15 segments detected by bronchoscopy. The length of stenosis as assessed intra-operatively significantly correlated with the data obtained with CT scan (r = 0.98, p < 0.001) and RB (r = 0.94, p < 0.001). The grade of stenosis was correctly assessed by bronchoscopy in 13/15 lesions (86%). CT measurements correctly estimated 15/16 (93.75%) lesions and allowed accurate measurements of the stenotic segment as well as the proximal and distal airway segments. Spiral CT scan with MPR and VE may be considered as a substitute to direct endoscopic examination and the additional information on laryngeal function can be easily obtained during flexible nasolaryngoscopic examination of the awake patient. This policy can minimize patient morbidity and spare them an extra anaesthetic for evaluation.

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