Computed Tomography Virtual Bronchoscopy: Normal Variants, Pitfalls, and Spectrum of Common and Rare Pathology

Abstract

A broad spectrum of pathologies that involve the laryngotracheobronchial airway and imaging plays a crucial role in evaluating these abnormalities. Computed tomography with virtual bronchoscopy has been found to be very helpful in defining the location, extent, and nature of these lesions, and is increasingly being used even in patients with contraindications for fiberoptic bronchoscopy and laryngoscopy. Ionizing radiation, associated with virtual bronchoscopy, can be minimized by using low-dose multidetector computed tomography and hybrid iterative reconstruction techniques. Furthermore, retrospectively generated virtual bronchoscopy from a routinely acquired computed tomography data set eliminates additional cost and radiation. In the future, virtual bronchoscopy assisted with advanced navigational techniques will broaden the diagnostic and therapeutic landscape. This article presents the characteristic features of common and rare laryngotracheobronchial pathologies seen with virtual bronchoscopy.

Virtual Bronchoscopy for Tumors and Traumatic Lesions of the Airways

“…Our study was conducted on the basis of the analysis of significant clinical material with the development of semiotic signs of TBS lesions and assessment of the diagnostic value of VB methods of their combined analysis with the results of native MSCT. Overall, our opinion about the necessity of wide application in clinical practice CT VB coincides with the result of the work appeared in recent years [11,13,15].…”

“…In contrast to the previous studies, when only the method of VB fly-through was used, it does not allow to agree with the opinion of the authors about the limited possibilities of VB in lung pathology [9,10]. Most of the studies on VB are based on individual clinical observations and literature data [10,11,14,15]. Our study was conducted on the basis of the analysis of significant clinical material with the development of semiotic signs of TBS lesions and assessment of the diagnostic value of VB methods of their combined analysis with the results of native MSCT.…”

“…Large bronchi may be secondarily affected in the central and peripheral forms of lung cancer [2][3][4]. The introduction of clinical practice of multispiral computed tomography (MSCT) clinical practice, new technologies of data collection, and post-processing image processing allowed developing a program of 3D reconstruction of the tracheobronchial system (TBS) with the ability to view its inner surface in real-time virtual bronchoscopy (VB) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. In addition to VB methods such as minimum and maximum intensity (MinIP, MIP) images, the mode of shaded surfaces-VTR allow to assess the state of the outer wall of the TBS, the relationship with adjacent organs and tissues [4,5,8,16].…”

“…In addition, the study of the bronchus distal to the stenosis at bronchoscopy is difficult and VB is the only method giving the possibility to evaluate the macrostructure of the bronchus beyond the area of narrowing [2,5,16]. The restrained attitude to VB of radiologists of foreign countries at the initial stage of data accumulation was replaced by a wide application of the method in clinical practice, as indicated by a significant increase in publications in recent years [2,3,[7][8][9][10][11][12][13]. The purpose of the study is to clarify the concept of VB techniques and their role in improving the diagnostic information content of CT in the diagnosis and prevalence of neoplastic lesions of TBS.…”

Reconstruction of esophageal stenosis that had persisted for 40 years using a free jejunal patch graft with virtual endoscopy assistance

“…While VE has several advantages, some limitations and pitfalls of VE have been reported. VE lacks the realtime capability of endoscopy, and it is prone to respiratory variations; airway patency may appear falsely compromised compared with the actual data [12]. Lower threshold values may falsely increase the apparent extent of stenosis, and, conversely, higher thresholds may erroneously indicate a mucosal gap [13].…”