Detektion von Atemwegsstenosen: Vergleich der virtuellen mit der flexiblen Bronchoskopie

Zusammenfassung

Ziel: Vergleich der virtuellen und der flexiblen Bronchoskopie bezüglich der Detektion von bronchialen Stenosen. Material und Methode: 26 mit flexibler Videobronchoskopie und virtueller Bronchoskopie an einem Mehrzeilen-Spiral-CT untersuchte Patienten wurden retrospektiv bezüglich der Detektion von Bronchusstenosen verglichen. Das Tracheobronchialsystem wurde in: Trachea, 2 Haupt-, 6 Lappen-, 18 Segment- und 36 Subsegmentbronchien = 63 Bronchusabschnitte eingeteilt. Unterschieden wurden: Stenosen < 50 %, von 50 - 95 % und komplette Verschlüsse. Ergebnisse: Die virtuelle Bronchoskopie zeigte 25, die flexible 17 Stenosen. Stenosen < 50 % fanden sich bei der virtuellen Bronchoskopie 14-mal, bei der flexiblen 10-mal, Stenosen von 50 - 95 % 7-mal bzw. 4-mal, komplette Verschlüsse 4-mal bzw. 3-mal. Die virtuelle Bronchoskopie zeigte eine nicht signifikant höhere Rate von Stenosen (Stenosen < 50 %: p = 0,352, 50 - 95 %: p = 0,339, komplette Verschlüsse: p = 0,696). Schlussfolgerung: Die virtuelle Bronchoskopie ermöglicht eine hochaufgelöste endoluminale Bildgebung der Bronchien bis zu den Segment- und Subsegmentbronchien. Sie ist bezüglich der Detektion von Stenosen der flexiblen Bronchoskopie überlegen.

Abstract

Purpose: To compare virtual with flexible bronchoscopy for the detection of bronchial stenoses. Materials and Methods: In a retrospective study, we compared the results of 26 patients, who had clinical suspected pathologies of the tracheobronchial airways and underwent both flexible bronchoscopy and multislice CT with 3D surface rendering of the airways. Flexible bronchoscopy and virtual bronchoscopy were compared as to the rate of detecting bronchial stenoses. For statistical analysis, we divided the tracheobronchial tree in the following sections: trachea, 2 main bronchi, 6 lobar bronchi, 18 segmental bronchi and 36 subsegmental bronchi, corresponding to 63 bronchial sections for each patient (on average) and a total of 1638 bronchial sections for all 26 patients. We graded the bronchial stenosis as less than 50 %, as 50 to 95 % and as complete obstruction. Results: Virtual bronchoscopy detected 25 bronchial stenoses, while flexible bronchoscopy only revealed 17 stenoses. Stenoses with a diameter less than 50 % were found with virtual bronchoscopy 14 times and with flexible bronchoscopy 10 times. Stenoses with a diameter between 50 and 95 % were detected 7 and 4 times, respectively, and complete obstructions 4 and 3 times, respectively. Tracheobronchial stenoses were well recognized with virtual bronchoscopy. Moreover, the virtual method enabled the visualization of high-grade stenoses and post-stenotic areas that could not be passed by the fiberoptic bronchoscope. Virtual bronchoscopy detected stenoses at a higher rate but the difference was not statistically significant (stenoses < 50 %: p = 0.352, 50 - 95 %: p = 0.339, complete obstruction: p = 0.696). Conclusion: Virtual bronchoscopy is a useful non-invasive method for the diagnostic evaluation of the tracheobronchial tree. In comparison with flexible bronchoscopy, virtual bronchoscopy is superior in revealing high-grade stenoses and visualizing post-stenotic areas.

Virtual bronchoscopy - 3D-reconstruction - fiberoptic bronchoscopy - stenotic bronchus - multislice computed tomography

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