Diagnostic Contribution of Virtual Endoscopy in Diseases of the Upper Airways

Abstract

Purpose: Virtual endoscopy (VE) is a new diagnostic tool that generates 3-dimensional (3D) views of a lumen by exploiting cross-sectional images. The purpose of this study was to evaluate the usefulness of VE as a diagnostic tool in the diseases of the larynx and pharynx. Materials and Methods: Twenty-two patients with a mean age of 57 years were included in the study. The patients underwent larynx examination, optical endoscopy (OE), and computed tomography (CT) of the larynx. Later, VE was produced from the CT images. Results: Eight patients had larynx carcinoma, a 5-yearold patient had a laryngeal web, a 43-year-old man had fish bone stuck in his submucosal layer, 10 patients were normal, and the remaining two patients were under follow-up for treated nasopharynx carcinoma and had no evidence for recurrence. VE showed the laryngeal tumor in seven patients and the laryngeal web in one patient, but failed to show a plaquelike tumor and the fishbone within the submucosa. Conclusions: Our findings suggest that VE is a useful and complimentary method of 3D imaging in the diseases compromising the laryngeal lumen. Furthermore, it may be superior to OE in severe stenosis or obstructions where the endoscope cannot be passed through.

Virtual endoscopy—a new assessment tool in difficult airway management

“…Virtual laryngoscopy has previously described advantages in obtaining views from below an obstructing lesion and in delineating vocal cord lesions [21] and multiple stenoses such as those seen in Wegener granulomatosis [22]. Benign and malignant intraluminal masses in the head and neck region have also been shown to be accurately reproduced using virtual imaging [17,21,23], which is consistent with our findings and fundamental for its utility in planning an airway strategy. Virtual imaging uniquely offers a noninvasive, safe, and accurate method to map the upper airway for difficult airway management planning.…”

Comparison of diagnostic accuracy of computed tomography virtual endoscopy and flexible fibre-optic laryngoscopy in the evaluation of neck anatomic structures and neoplasms

“…In comparison to FFL, VE has been found to be particularly useful in cases of severe stenosis, which the conventional endoscope cannot pass through. 7 , 8 , 10 , 15 , 16 Besides, with the volumetric data and reconstructions, the area of stenosis can be viewed from different angulations and sides. 17 , 18 Furthermore, this modality can be used when the patient cannot tolerate FFL, allowing the assessment of the airway without the use of general anaesthesia and exposure to associated risks such as trauma to the teeth, the neck and the airway.…”

“…8 , 14 On the other hand, VE has multiple limitations described by several studies, including radiation exposure and the inability to identify mucosal irregularities or flat lesions. 7 , 8 , 16 , 19 Moreover, this technique cannot give real-time imaging, 16 whereas in endoscopy, the visualisation of the airway mucosa allows the evaluation of the intraluminal anatomy, the morphology, vascularisation and colour of the mucosa, 12 giving the opportunity to recognise abnormalities and take tissue samples. 8 , 10 Additionally, the quality of the images depends on the collaboration of the patient, 10 and it requires specialised software and time to do the reconstructions, thereby increasing the costs, 11 although with technology improvement, the reconstructions are quicker and with better detail.…”

The effect of virtual endoscopy on diagnostic accuracy and airway management strategies in patients with head and neck pathology: a prospective cohort study

“…This has been shown previously by the broad applicability of VE as a diagnostic tool in a number of medical specialties, such as radiology and thoracic surgery, for lesions in the head and neck, trachea, and bronchial tree. [23][24][25][26][27][28][29][30][31][32] Nørskov et al found that, in almost half of the patients with anticipated difficult tracheal intubation, the anesthesiologist planned to attempt direct laryngoscopy for intubation, even when difficult intubation and difficult face mask ventilation were anticipated. 7 We have shown that there was a change in the airway management plan in half of the cases when VE videos were reviewed, with the vast majority changing to a more cautious plan (90.6%).…”