HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Boiselle, P. M. Articles by Ernst, A. Search for Related Content PubMed PubMed Citation Articles by Boiselle, P. M. Articles by Ernst, A. Social Bookmarking                      What's this?

Multiplanar and Three-Dimensional Imaging of the Central Airways with Multidetector CT

¹ Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.
² Department of Pulmonary Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.

View larger version (115K): [in a new window]   Fig. 1A. —Axial, multiplanar, and three-dimensional (3D) CT images of central airways in 57-year-old man with non—small cell lung cancer and bronchoscopically proven airway invasion. Axial contrast-enhanced CT image obtained at level of aorticopulmonary window shows large nodal mass (N) compressing carina. Origin of right mainstem bronchus (arrow) is severely narrowed but is difficult to fully assess because of its oblique orientation with respect to axial plane.

View larger version (85K): [in a new window]   Fig. 1B. —Axial, multiplanar, and three-dimensional (3D) CT images of central airways in 57-year-old man with non—small cell lung cancer and bronchoscopically proven airway invasion. Three-dimensional external-rendered CT image of airway shows irregular deformity of distal trachea and carina and severe narrowing of proximal right mainstem bronchus (arrow) with distal patency. Compared with axial images, such as A, 3D perspective provides more accurate assessment of overall extent of airway involvement.

View larger version (77K): [in a new window]   Fig. 1C. —Axial, multiplanar, and three-dimensional (3D) CT images of central airways in 57-year-old man with non—small cell lung cancer and bronchoscopically proven airway invasion. Coronal multiplanar volume reformation CT image complements findings from 3D image (B) by showing relationship of large nodal mass (N) to airway.

View larger version (103K): [in a new window]   Fig. 2A. —Axial and three-dimensional (3D) images of central airways in 46-year-old woman with left mainstem bronchial stenosis resulting from prior tuberculosis infection. Craniocaudal extent and severity of stenosis were underestimated on axial CT images (A-D) but were accurately identified on basis of 3D reconstruction (E). Axial CT image obtained at level of carina shows subtle minimal wall thickening at origin of left mainstem bronchus (arrow).

View larger version (103K): [in a new window]   Fig. 2B. —Axial and three-dimensional (3D) images of central airways in 46-year-old woman with left mainstem bronchial stenosis resulting from prior tuberculosis infection. Craniocaudal extent and severity of stenosis were underestimated on axial CT images (A-D) but were accurately identified on basis of 3D reconstruction (E). Axial CT image obtained at slightly lower level than A shows subtle asymmetry in size of left mainstem bronchus (L) compared with right (R).

View larger version (109K): [in a new window]   Fig. 2C. —Axial and three-dimensional (3D) images of central airways in 46-year-old woman with left mainstem bronchial stenosis resulting from prior tuberculosis infection. Craniocaudal extent and severity of stenosis were underestimated on axial CT images (A-D) but were accurately identified on basis of 3D reconstruction (E). Axial CT image obtained at slightly lower level than B shows thickening of anterior wall of left mainstem bronchus (arrow). Calcified subcarinal lymph node is incidentally noted.

View larger version (80K): [in a new window]   Fig. 2D. —Axial and three-dimensional (3D) images of central airways in 46-year-old woman with left mainstem bronchial stenosis resulting from prior tuberculosis infection. Craniocaudal extent and severity of stenosis were underestimated on axial CT images (A-D) but were accurately identified on basis of 3D reconstruction (E). Axial CT image obtained at slightly lower level than C shows further extension of bronchial wall thickening (arrow).

View larger version (166K): [in a new window]   Fig. 2E. —Axial and three-dimensional (3D) images of central airways in 46-year-old woman with left mainstem bronchial stenosis resulting from prior tuberculosis infection. Craniocaudal extent and severity of stenosis were underestimated on axial CT images (A-D) but were accurately identified on basis of 3D reconstruction (E). Three-dimensional image of air-ways shows long segment of stenosis of left mainstem bronchus (arrows). Severity and length of stenosis correlated with findings at conventional bronchoscopy.

View larger version (151K): [in a new window]   Fig. 3. —Anomalous origin of right upper lobe segmental bronchi from right mainstem bronchus in 7-year-old girl with recurrent respiratory infections. Prior single-detector CT scan (not shown) was nondiagnostic because of respiratory motion. Multidetector CT scan was obtained in 4 sec and provided information that changed preoperative plan from lobectomy to segmentectomy. External three-dimensional volume-rendered image shows anomalous segmental bronchi (apical bronchus = 1, anterior bronchus = 2, posterior bronchus = 3) originate directly from right mainstem bronchus rather than from traditional right upper lobe bronchus. Severe bronchiectasis (arrows) in anterior segment can also be seen as well as mosaic pattern of lung attenuation. R = right, S = superior.

View larger version (92K): [in a new window]   Fig. 4. —Idiopathic subglottic stenosis in 57-year-old woman. Three-dimensional (3D) external volume-rendered CT image of airway reveals focal subglottic stenosis (arrows). Airway stenoses are often more clearly depicted on 3D images than on axial images.

View larger version (140K): [in a new window]   Fig. 5A. —Extrinsic tracheal compression caused by thyroid goiter in 48-year-old woman. Three-dimensional external-rendered CT image of trachea shows smoothly marginated narrowing above level of thoracic inlet. To emphasize relationship of airway and skeletal landmarks of thoracic inlet, we chose reconstruction algorithm that extracted thyroid gland.

View larger version (156K): [in a new window]   Fig. 5C. —Extrinsic tracheal compression caused by thyroid goiter in 48-year-old woman. Three-dimensional internal-rendered CT image of trachea obtained at level of thyroid gland shows symmetric narrowing caused by extrinsic compression.

View larger version (98K): [in a new window]   Fig. 5D. —Extrinsic tracheal compression caused by thyroid goiter in 48-year-old woman. Conventional bronchoscopic image of trachea obtained at same level as B shows similar degree of symmetric narrowing of trachea at level of thyroid gland.

View larger version (126K): [in a new window]   Fig. 6. —Postoperative granulation polyp causing airway compromise in 24-year-old man who had previously undergone tracheal surgery. Virtual bronchoscopic image shows large anterior polyp projecting into tracheal lumen. Diagnosis of granulation polyp was made at bronchoscopic biopsy.

View larger version (123K): [in a new window]   Fig. 7A. —False-positive virtual bronchoscopic finding in 55-year-old man. Virtual bronchoscopic image obtained looking down trachea toward carina reveals focal polypoid lesion (arrow) along posterior wall of trachea.

View larger version (91K): [in a new window]   Fig. 7B. —False-positive virtual bronchoscopic finding in 55-year-old man. Axial CT image obtained at same level as A using lung window settings shows dependent airway opacity with several gas bubbles (arrows), which is characteristic appearance of retained secretions.

View larger version (73K): [in a new window]   Fig. 8A. —Virtual bronchoscopic assessment of bronchial anastomosis stenosis and distal airways in 56-year-old man who had undergone right lung transplantation for emphysema. Three-dimensional external-rendered CT image of airway shows focal narrowing of airway (arrows) at site of bronchial anastomosis.

View larger version (93K): [in a new window]   Fig. 8B. —Virtual bronchoscopic assessment of bronchial anastomosis stenosis and distal airways in 56-year-old man who had undergone right lung transplantation for emphysema. Virtual bronchoscopic image obtained at level of carina shows severe stenosis (arrows) at anastomosis site and normal appearance of left mainstem bronchus.

View larger version (114K): [in a new window]   Fig. 8C. —Virtual bronchoscopic assessment of bronchial anastomosis stenosis and distal airways in 56-year-old man who had undergone right lung transplantation for emphysema. Virtual bronchoscopic image obtained at slightly lower level than B, looking down right mainstem bronchus, shows severe stenosis (arrows). Image has been slightly rotated to offer perspective similar to conventional bronchoscopic image (D). R = right, P = posterior.

View larger version (121K): [in a new window]   Fig. 8D. —Virtual bronchoscopic assessment of bronchial anastomosis stenosis and distal airways in 56-year-old man who had undergone right lung transplantation for emphysema. Conventional bronchoscopic image obtained at same level as B shows tight stenosis (arrow) at anastomosis site, beyond which bronchoscope could not pass.

View larger version (95K): [in a new window]   Fig. 8E. —Virtual bronchoscopic assessment of bronchial anastomosis stenosis and distal airways in 56-year-old man who had undergone right lung transplantation for emphysema. Virtual bronchoscopic image obtained distal to site of stenosis shows normal appearance of airways in transplanted lung.

View larger version (69K): [in a new window]   Fig. 9A. —Extrinsic bronchial compression from bronchogenic cyst in 51-year-old woman with recurrent left lower lobe pneumonias. Curved oblique two-dimensional multiplanar volume reformation image obtained along axis of left airway shows narrowing of left lower lobe bronchus as a result of extrinsic compression by adjacent mass (red), which was proven to represent bronchogenic cyst at surgery.

View larger version (97K): [in a new window]   Fig. 9B. —Extrinsic bronchial compression from bronchogenic cyst in 51-year-old woman with recurrent left lower lobe pneumonias. Conventional bronchoscopic image obtained at level of left lower lobe bronchus shows extrinsic compression from adjacent bulging cyst.

View larger version (158K): [in a new window]   Fig. 9C. —Extrinsic bronchial compression from bronchogenic cyst in 51-year-old woman with recurrent left lower lobe pneumonias. Three-dimensional external-rendered CT image shows relationship of cyst (red) and bronchi from different perspective.

View larger version (113K): [in a new window]   Fig. 10. —Rotational "paddle-wheel" reformation method of normal central airways in 57-year-old man. Paddle-wheel multiplanar volume reformation image shows central airways in continuous display on single image. Minimum-intensity-projection algorithm, which highlights minimum-density voxels such as air-filled structures, was used to enhance visibility of airways in lung parenchyma. Also note evidence of emphysema.

View larger version (124K): [in a new window]   Fig. 11A. —Tracheomalacia in 36-year-old woman with dyspnea and cough. Sagittal multiplanar volume reformation image obtained at end-inspiration shows normal caliber (arrows) of trachea (T). Air-filled structure posterior to trachea represents slightly distended esophagus.

View larger version (146K): [in a new window]   Fig. 11B. —Tracheomalacia in 36-year-old woman with dyspnea and cough. Sagittal multiplanar volume reformation image obtained during dynamic breathing shows excessive collapse (arrows) of intrathoracic trachea (T), consistent with tracheomalacia, which was confirmed at conventional bronchoscopy. Grainy appearance of image reflects use of low-dose technique (40 mA).

View larger version (60K): [in a new window]   Fig. 12. —Airway obstruction and stenosis caused by non—small cell lung cancer in 56-year-old woman. Coronal minimal-intensity-projection multiplanar volume reformation image shows complete obstruction of bronchus intermedius (thick arrow) and narrowing of left mainstem bronchus (thin arrows). Although bronchus intermedius obstruction was seen equally well with axial images, length and severity of left mainstem bronchus narrowing were underestimated on axial images (not shown).

View larger version (114K): [in a new window]   Fig. 5B. —Extrinsic tracheal compression caused by thyroid goiter in 48-year-old woman. Coronal multiplanar volume reformation image shows relationship of enlarged thyroid gland (red) to trachea.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati