American Journal of Roentgenology, Vol 169, 1591-1595, Copyright © 1997 by American Roentgen Ray Society

ARTICLES

Comparison of real-time virtual and fiberoptic bronchoscopy in patients with bronchial carcinoma: opportunities and limitations

T Fleiter, EM Merkle, AJ Aschoff, G Lang, M Stein, J Gorich, F Liewald, N Rilinger and R Sokiranski
Department of Diagnostic Imaging, University of Ulm, Germany.

OBJECTIVE: Both helical CT and fiberoptic bronchoscopy are used in the staging of pulmonary tumors for therapeutic decision making. The improved resolution offered by helical CT has led to the clinical use of three-dimensional reconstruction techniques such as virtual bronchoscopy. We tested this new simulated endoscopic view of inner organ surfaces and compared it with corresponding fiberoptic examinations of the tracheobronchial system. SUBJECTS AND METHODS: Twenty patients with malignancies of the lung and mediastinum were examined with both virtual bronchoscopy and fiberoptic bronchoscopy. Both examinations were reviewed by radiologists and surgeons familiar with fiberoptic bronchoscopy. Virtual bronchoscopy was calculated and reconstructed from the cross-sectional images on a separate workstation. Stenoses and tumor infiltration were classified from the fiberoptic examination. These results were compared with the virtual bronchoscopy findings. RESULTS: Virtual bronchoscopy of diagnostic quality was achieved in 19 of 20 patients. High-grade stenoses were revealed equally well with virtual and fiberoptic techniques. Virtual bronchoscopy offered the advantage of being able to visualize areas beyond even high-grade stenoses. However, on virtual bronchoscopy discrete infiltration or extraluminal impression was not visible in five patients. In another patient, strong heart pulsation produced motion artifacts that prevented evaluation of the reconstruction. CONCLUSION: Virtual bronchoscopy represents a new noninvasive method for evaluating helical CT findings. In comparison with fiberoptic bronchoscopy, virtual bronchoscopy offers the advantage of being able to visualize areas beyond even high-grade stenoses. In addition to the limited view of fiberoptic bronchoscopy, extraluminal causes of lumen compressions can be analyzed in the cross-sectional images and evaluated together with the virtual representation. However, it was not possible to detect small infiltrations with virtual bronchoscopy. This new representation of helical CT data might be helpful for postoperative follow-up examinations, such as after stent implantation, and can be carried out without additional risk to the patient. Radiologists do need special fiberoptic bronchoscopy knowledge and experience with three-dimensional-reconstructions to differentiate between real stenoses and artificial stenoses that might be caused by pulsation artifacts.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. M. Heyer, T. G. Nuesslein, D. Jung, S. A. Peters, S. P. Lemburg, C. H. L. Rieger, and V. Nicolas Tracheobronchial Anomalies and Stenoses: Detection with Low-Dose Multidetector CT with Virtual Tracheobronchoscopy--Comparison with Flexible Tracheobronchoscopy Radiology, February 1, 2007; 242(2): 542 - 549. [Abstract] [Full Text] [PDF]

				F. Asano, Y. Matsuno, N. Shinagawa, K. Yamazaki, T. Suzuki, T. Ishida, and H. Moriya A virtual bronchoscopic navigation system for pulmonary peripheral lesions. Chest, August 1, 2006; 130(2): 559 - 566. [Abstract] [Full Text] [PDF]

				D. Shitrit, P. Valdsislav, A. Grubstein, D. Bendayan, M. Cohen, and M. R. Kramer Accuracy of Virtual Bronchoscopy for Grading Tracheobronchial Stenosis: Correlation With Pulmonary Function Test and Fiberoptic Bronchoscopy Chest, November 1, 2005; 128(5): 3545 - 3550. [Abstract] [Full Text] [PDF]

				S. I. Sersar, U. A. Hamza, W. A. AbdelHameed, R. A. AbulMaaty, N. N. Gowaeli, S. A. Moussa, S. M. AlMorsi, and M. M. Hafez Inhaled foreign bodies: management according to early or late presentation Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 369 - 374. [Abstract] [Full Text] [PDF]

				C. M. Jones and T. Athanasiou Is Virtual Bronchoscopy an Efficient Diagnostic Tool for the Thoracic Surgeon? Ann. Thorac. Surg., January 1, 2005; 79(1): 365 - 374. [Abstract] [Full Text] [PDF]

				K Dheda, C M Roberts, M R Partridge, and I Mootoosamy Is virtual bronchoscopy useful for physicians practising in a district general hospital? Postgrad. Med. J., July 1, 2004; 80(945): 420 - 423. [Abstract] [Full Text] [PDF]

				W. De Wever, V. Vandecaveye, S. Lanciotti, and J.A. Verschakelen Multidetector CT-generated virtual bronchoscopy: an illustrated review of the potential clinical indications Eur. Respir. J., May 1, 2004; 23(5): 776 - 782. [Abstract] [Full Text] [PDF]

				Y. Lacasse, S. Martel, A. Hebert, G. Carrier, and B. Raby Accuracy of virtual bronchoscopy to detect endobronchial lesions Ann. Thorac. Surg., May 1, 2004; 77(5): 1774 - 1780. [Abstract] [Full Text] [PDF]

				H. Hoppe, H.-P. Dinkel, B. Walder, G. von Allmen, M. Gugger, and P. Vock Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy Chest, February 1, 2004; 125(2): 704 - 711. [Abstract] [Full Text] [PDF]

				S. E. Finkelstein, D. S. Schrump, D. M. Nguyen, S. M. Hewitt, T. F. Kunst, and R. M. Summers Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies Chest, November 1, 2003; 124(5): 1834 - 1840. [Abstract] [Full Text] [PDF]

				P. M. Boiselle, K. F. Reynolds, and A. Ernst Multiplanar and Three-Dimensional Imaging of the Central Airways with Multidetector CT Am. J. Roentgenol., August 1, 2002; 179(2): 301 - 308. [Full Text] [PDF]

				S. E. Finkelstein, R. M. Summers, D. M. Nguyen, J. H. Stewart IV, J. A. Tretler, and D. S. Schrump Virtual bronchoscopy for evaluation of malignant tumors of the thorax J. Thorac. Cardiovasc. Surg., May 1, 2002; 123(5): 967 - 972. [Abstract] [Full Text] [PDF]

				H. Hoppe, B. Walder, M. Sonnenschein, P. Vock, and H.-P. Dinkel Multidetector CT Virtual Bronchoscopy to Grade Tracheobronchial Stenosis Am. J. Roentgenol., May 1, 2002; 178(5): 1195 - 1200. [Abstract] [Full Text] [PDF]

				C. Schaefer-Prokop and M. Prokop New imaging techniques in the treatment guidelines for lung cancer Eur. Respir. J., February 1, 2002; 19(35_suppl): 71S - 83s. [Abstract] [Full Text] [PDF]

				R. M. Summers, N. R. Aggarwal, M. C. Sneller, M. J. Cowan, B. J. Wood, C. A. Langford, and J. H. Shelhamer CT Virtual Bronchoscopy of the Central Airways in Patients With Wegener's Granulomatosis Chest, January 1, 2002; 121(1): 242 - 250. [Abstract] [Full Text] [PDF]

				G.R. Ferretti, I. Bricault, and M. Coulomb Virtual tools for imaging of the thorax Eur. Respir. J., August 1, 2001; 18(2): 381 - 392. [Abstract] [Full Text] [PDF]

				P. M. Boiselle, A. Ernst, and D. D. Karp Lung Cancer Detection in the 21st Century: Potential Contributions and Challenges of Emerging Technologies Am. J. Roentgenol., November 1, 2000; 175(5): 1215 - 1221. [Full Text] [PDF]

				C. Laroche, I. Fairbairn, H. Moss, J. Pepke-Zaba, L. Sharples, C. Flower, and R. Coulden Role of computed tomographic scanning of the thorax prior to bronchoscopy in the investigation of suspected lung cancer Thorax, May 1, 2000; 55(5): 359 - 363. [Abstract] [Full Text]

				G. R. Ferretti, F. Thony, J.-L. Bosson, C. Pison, F. Arbib, and M. Coulomb Benign Abnormalities and Carcinoid Tumors of the Central Airways: Diagnostic Impact of CT Bronchography Am. J. Roentgenol., May 1, 2000; 174(5): 1307 - 1313. [Abstract] [Full Text] [PDF]

				K. D. Hopper, T. A. Lucas, K. Gleeson, J. L. Stauffer, R. Bascom, D. T. Mauger, and R. Mahraj Transbronchial Biopsy with Virtual CT Bronchoscopy and Nodal Highlighting Radiology, November 1, 2001; 221(2): 531 - 536. [Abstract] [Full Text] [PDF]