Airway stenosis: CT evaluation of endoscopic treatment

Transcription

1 Airway stenosis: CT evaluation of endoscopic treatment Poster No.: C-0334 Congress: ECR 2012 Type: Scientific Exhibit Authors: N. Maggialetti, M. Ficco, A. A. A. Stabile Ianora, M. Moschetta, A. Scardapane, G. Angelelli; Bari/IT Keywords: Obstruction / Occlusion, Neoplasia, Infection, Computer Applications-Detection, diagnosis, Computer Applications-3D, Comparative studies, CT, Mediastinum, Lung, Computer applications DOI: /ecr2012/C-0334 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 16

2 Purpose Endobronchial stent placement under endoscopic guidance is almost an ordinary procedure in treating airway stenoses, which are secondary to benign or malignant diseases not responding to other treatments. The role of 2D-3D imaging, based on multislice CT, acquired in studying the pre-and post- stent implantation of tracheobronchial airway lesions, was evaluated and the data obtained were compared with those of conventional bronchoscopy. Page 2 of 16

3 Images for this section: Fig. 1 Page 3 of 16

4 Methods and Materials 34 patients (23 M, 11 F, mean age 57 years) underwent 16-slice CT and bronchoscopy. For each patient, acquisitions were performed without contrast medium by using the following parameters Thickness :1 mm Increment: 0,8 mm Pitch: 1,75 Rotation time: 0,5 sec KVp/mAs: 120/250 Coverage: hyoid bone - diaphragm Evaluation of pre-implantation was performed on: tracheo-bronchial diameters stenosis presence, location and length airway patency distance of the stenosing lesion proximal side from landmarks (vocal cords, carina) Evaluation of stenting cases provided information on: airway patency Incidence of complications (stent migration, dissection, obstruction, infection, fracture) Evaluation of the control group was carried out on : diameter of the middle third of trachea diameters of the bronchi at the level of the proximal third. All parameters were assessed by MPR and 3D reconstructions (MIP MiniP, VR) [Fig. 2] in order to find any significant difference between the programs used. The results were evaluated by statistical methods using the Bonferroni test for multiple variables. Page 4 of 16

5 Images for this section: Fig. 1 Page 5 of 16

6 Fig. 2: Our data were confirmed by bronchoscopy Page 6 of 16

7 Results 19 patients with airway stenosis (79% malignant, 21% post-intubation or post-infectious) [fig 3-4] underwent stent placement. 15 patients were in the control group. In 3 / 19 cases (16%) post-implantation complications occurred. [Figure 5]. The MPR reconstructions were more accurate in the quantification of stenosis, in the airway diameter and in the post-implantation diagnosis. (p <0.05) compared to 3D. In assessing the stenosis length, MIP and VR reconstructions as well as MinIP reconstructions overestimated and underestimated respectively this parameter rather than the MPR ones (p <0.01). In evaluating the diameter of the maximum stenosis point, MIP and VR reconstructions as well as reconstructions MinIP underestimated and overestimated respectively the variable rather than the MPR ones (p <0.05) The analysis of the trachea and stent diameter at the point of maximum stenosis confirmed the tendency to the underestimation of MIP and VR reconstructions and the overestimation of MinIP reconstructions rather than the MPR ones. Our results were reported in graphics [fig 6-8] Page 7 of 16

8 Images for this section: Fig. 3: a vegetant lesion in the middle third of trachea; This lesion determinate a partial trachea stenosis. MPR and VR reconstructions Page 8 of 16

9 Fig. 4: Non-neoplastic stenosis (Post-tubercular)of the left main bronchus. Evaluation with the various programs of reconstruction (MPR, VR, MIP, MinIP and EV) and bronchoscopy. Page 9 of 16

10 Fig. 5: Endobronchial complications post stent implantation. CT reconstructions (MPR and EV) and bronchoscopy. the stent is obstructed in the middle third of the presence of a mucus plug. Page 10 of 16

11 Fig. 6 Fig. 7 Page 11 of 16

12 Fig. 8 Page 12 of 16

13 Conclusion The CT reconstructions allow an accurate quantitative and morphological evaluation of the airway stenosing lesions. Our study showed a higher accuracy of the MPR rather than other reconstruction techniques. In fact, in carrying out the preoperative assessment of patients with airway stenosis, the MPR reconstructions provide, by a non-invasive technique, information on the tracheobronchial tree morphology and allow adequate quantitative evaluation of stenosis, useful for the correct therapeutic approach. After stent placement, follow up data allow to monitor the therapeutic response to local treatment easily and to recognize any complications [Figure 9] Page 13 of 16

14 Images for this section: Fig. 9: MPR and 3D reconstructions in patients with stent migration and formation of granulation tissue at the distal margin of the prosthesis (arrow) and associated reduction of the lumen Page 14 of 16

15 References Grenier PA, Beigelman-Aubry C, Fétita C et al.new frontiers in CT imaging of airway disease. Eur Radiol 2002;12: Dialani V, Ernst A, Sun M et al.mdct detection of airway stent complications: comparison with bronchoscopy. Am J Roentgenol. 2008;191: Sun M, Ernst A, Boiselle PM.MDCT of the central airways: comparison with bronchoscopy in the evaluation of complications of endotracheal and tracheostomy tubes.j Thorac Imaging. 2007; 22: Ferretti G, Jankowski A, Righini C et al. Multidetector CT evaluation of airway metallic stents. Rev Mal Respir. 2007; 24: Grenier PA, Beigelman-Aubry C, Brillet PY.Non-neoplastic tracheal and bronchial stenoses.radiol Clin North Am. 2009; 47: Meduri S, De Petri T, Modesto A et al. Multislice CT: technical principles and clinical applications.radiol Med. 2002;103: Loizzi M, Costantino M, Genualdo M et al. TC spirale multistrato con ricostruzioni nella valutazione morfo-dimensionale delle lesioni stenoostruttive della via aerea principale. In Attualità in Chirurgia Toracica. Ed. De Nicola, Napoli Page 15 of 16

16 Personal Information Nicola Maggialetti MD. Department of Radiology Università degli Studi di Bari, Italy Page 16 of 16