ABSTRACT
Objectives: The aim of this study was to evaluate the accuracy of Mlti detector CT with multiplanar reconstruction images, virtual bronchoscopy [VB] and volume rendering technique compared to the results of fiber-optic bronchoscopy [FOB] in defining bronchial pathologies in patients with pulmonary neoplasms
Methods: Fifty four patients with symptoms or chest X-ray abnormality raising the suspicion of pulmonary neoplasm in which FOB and CT chest were ordered for the initial investigation. Patients underwent both FOB and MDCT
Results: Fifty four patients were enrolled in the study [including 41 with an endobronchial lesion at FB] the sensitivity and specificity of VB to detect endobronchial lesions were 100% and 86.7% respectively [95% CI]. The positive and negative predictive values of VB were 95.3% and 100% respectively. The accuracy was 962%. Overall, the agreement between VB and FOB regarding the location on endobronchial lesions was perfect [weighted kappa: 0.9]. In 12 cases with obstruction of the main bronchi [5 in left main, 7 in right main bronchus], VB is able to bypass beyond the mass level in 4 cases [33.3% of cases]. The FOB was able to bypass beyond the mass lesion in only 2 cases [16.7% of cases], both of them were partially obstructing masses. FOB cannot by pass beyond the mass level in any case with totally obstructing mass. As regard to the extrabronchial structures evaluation, 34 of the 41 endobronchial lesions were associated with extrabronchial part of the endobronchial lesion [ratio about 63% of cases]. The FOB was not able to detect the extra-bronchial lesions in any case. In evaluating extrinsic compressions of the airway, FOB detected 11 lesions; VB+MPR [multi planar reconstruction] detected 10 lesions [5 of them caused by enlarged LNS, the remaining 5 were caused by extrabronchial soft tissue mass], VB could not see one of the external compressions with sensitivity, specificity 90.0% and 97.6% respectively. Curved planar reformation detected 13 lesions with sensitivity, specificity 90.9% and 95.3% respectively. Volume rendering detected 12 lesions with sensitivity, specificity 100.0% and 97.7% respectively. While FOB detected 4 mucosal lesions, VB cannot detect any of them with sensitivity and specificity 0%
Conclusion: VB is an extremely useful modality for evaluation of bronchial lesions, it is noninvasive, and the ability to examine 2D and 3D anatomic detail from multiple directions enables precise assessment of intraluminal, extent of the extraluminal diseases or airway patency distal to high-grade bronchial stenosis. We concluded that multi-slice CT in connection with VB became an essential complementary to FOB in selected patients with bronchial lesions