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Low-Dose MDCT for Surveillance of Patients with Severe Homogeneous Emphysema After Bronchoscopic Airway Bypass

¹ Department of Nuclear Medicine, Universitätsklinikum des Saarlandes, Kirrbergerstr. 1, 66421 Homburg, Saarland, Germany.
² Department of Diagnostic and Interventional Radiology, University Hospital Saarland, Homburg, Saarland, Germany.
³ Department of Internal Medicine V, University Hospital Saarland, Homburg, Saarland, Germany.
⁴ Institute of Radiology and Nuclear Medicine, Pirmasens, Germany.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Drug-eluting stent. Photographs show stent (arrow) en face (A) and in profile (B).

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Drug-eluting stent. Photographs show stent (arrow) en face (A) and in profile (B).

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Drug-eluting stent. CT scans in bone (C) and lung (D) windows show stent (arrow) in profile outside patient.

View larger version (31K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Drug-eluting stent. CT scans in bone (C) and lung (D) windows show stent (arrow) in profile outside patient.

View larger version (47K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —76-year-old woman with inappropriate positioning of stent. Paraaxial multiplanar reformations in bone (A) and lung (B) windows show inappropriate positioning of stent (arrow) in relation to bronchial wall 1 week after stent implantation. At examination 1 month after stent placement, stent was dislodged and expectorated (not shown).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —76-year-old woman with inappropriate positioning of stent. Paraaxial multiplanar reformations in bone (A) and lung (B) windows show inappropriate positioning of stent (arrow) in relation to bronchial wall 1 week after stent implantation. At examination 1 month after stent placement, stent was dislodged and expectorated (not shown).

View larger version (35K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —55-year-old woman with level 1 and level 5 stents. Parasagittal multiplanar reformations in bone (A) and lung (B) windows show correctly positioned (level 1) stent (arrow) in relation to bronchial wall with clearly open lumen.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —55-year-old woman with level 1 and level 5 stents. Parasagittal multiplanar reformations in bone (A) and lung (B) windows show correctly positioned (level 1) stent (arrow) in relation to bronchial wall with clearly open lumen.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —55-year-old woman with level 1 and level 5 stents. Curved planar multiplanar reformations along upper lobe bronchus in bone (C) and lung (D) windows show definitively occluded (level 5) stent (arrow) completely surrounded by granulation tissue.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —55-year-old woman with level 1 and level 5 stents. Curved planar multiplanar reformations along upper lobe bronchus in bone (C) and lung (D) windows show definitively occluded (level 5) stent (arrow) completely surrounded by granulation tissue.

View larger version (39K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —63-year-old man with emphysema and level 2 and level 4 stents. Paraaxial multiplanar reformations in bone (A) and lung (B) windows show stent (arrow) is not perpendicular to bronchial wall but has unequivocally open lumen (level 2).

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —63-year-old man with emphysema and level 2 and level 4 stents. Paraaxial multiplanar reformations in bone (A) and lung (B) windows show stent (arrow) is not perpendicular to bronchial wall but has unequivocally open lumen (level 2).

View larger version (36K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —63-year-old man with emphysema and level 2 and level 4 stents. Paraaxial multiplanar reformations in bone (C) and lung (D) windows show probably nonfunctioning (level 4) stent (arrow) in anterior aspect of anterior basal segmental bronchus of right lower lobe without unequivocally open lumen. Granulation tissue was confirmed at bronchoscopy. Stent (arrowhead) in posterior basal segmental bronchus of right lower lobe has unequivocally open lumen (level 1).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —63-year-old man with emphysema and level 2 and level 4 stents. Paraaxial multiplanar reformations in bone (C) and lung (D) windows show probably nonfunctioning (level 4) stent (arrow) in anterior aspect of anterior basal segmental bronchus of right lower lobe without unequivocally open lumen. Granulation tissue was confirmed at bronchoscopy. Stent (arrowhead) in posterior basal segmental bronchus of right lower lobe has unequivocally open lumen (level 1).

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —65-year-old woman with emphysema and level 3 stent. Paraaxial multiplanar reformations in bone (A) and lung (B) windows show stent (arrow) not perpendicular to bronchial wall in right lower lobe and not clearly directed to lung parenchyma.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —65-year-old woman with emphysema and level 3 stent. Paraaxial multiplanar reformations in bone (A) and lung (B) windows show stent (arrow) not perpendicular to bronchial wall in right lower lobe and not clearly directed to lung parenchyma.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Graph shows results of receiver operating characteristic analysis of reader performance for stent patency (dotted line) (Az = 0.995).

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —55-year-old woman with stent surrounded by vessels. Paracoronal multiplanar reformations in bone (A) and lung (B) windows show stent (arrowhead) positioned close to bronchi and vessels. Although appropriately positioned in relation to bronchial wall, stent is covered by lung tissue (confirmed at bronchoscopy) and therefore is not functioning. Proximity to pulmonary vessels and bronchi can prompt radiologist to diagnose nonfunctioning stent.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —55-year-old woman with stent surrounded by vessels. Paracoronal multiplanar reformations in bone (A) and lung (B) windows show stent (arrowhead) positioned close to bronchi and vessels. Although appropriately positioned in relation to bronchial wall, stent is covered by lung tissue (confirmed at bronchoscopy) and therefore is not functioning. Proximity to pulmonary vessels and bronchi can prompt radiologist to diagnose nonfunctioning stent.

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