Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography

Abstract

Objectives To determine the feasibility of long-range optical coherence tomography (LR-OCT) as a tool to intraoperatively image and measure the subglottis and trachea during suspension microlaryngoscopy before and after endoscopic treatment of subglottic stenosis (SGS). Methods Long-range optical coherence tomography of the adult subglottis and trachea was performed during suspension microlaryngoscopy before and after endoscopic treatment for SGS. The anteroposterior and transverse diameters, cross-sectional area (CSA), distance from the vocal cords, and length of the SGS were measured using a MATLAB software. Pre-intervention and postintervention airway dimensions were compared. Three-dimensional volumetric airway reconstructions were generated using medical image processing software (MIMICS). Results Intraoperative LR-OCT imaging was performed in 3 patients undergoing endoscopic management of SGS. Statistically significant differences in mean anteroposterior diameter (P < .01), transverse diameter (P < .001), and CSA (P < .001) were noted between pre-intervention and postintervention data. Three-dimensional airway models were viewed in cross-sectional format and via virtual “fly through” bronchoscopy. Conclusions This is the first report of intraoperative LR-OCT of the subglottic and tracheal airway before and after surgical management of SGS in humans. Long-range optical coherence tomography offers a practical means to measure the dimensions of SGS and acquire objective data on the response to endoscopic treatment of SGS.

Airway compliance measured by anatomic optical coherence tomography

“…For assessing tissue biomechanical properties, aOCT has been applied to quantify CSA vs. pressure at the velo-, oro-, and hypopharynx while investigating OSA pathophysiology [16] and to study regional changes in central airway CC in individuals suffering from asthma, COPD, and bronchiectasis [17]. Recently, SSaOCT was used to quantify luminal geometry changes intraoperatively before and after laryngeal microsurgery for treating subglottic stenosis [18].…”

Upper airway reconstruction using long‐range optical coherence tomography: Effects of airway curvature on airflow resistance

“…LR‐OCT imaging is currently possible during awake endoscopy in adults as demonstrated by our group . With the constraints of the current study, the use of LR‐OCT was limited to sedated endoscopy, requiring the presence of an ET tube.…”

“…Long‐range OCT (LR‐OCT) is the use of this technique with an emphasis on longer range capture of airway wall location to quantify size and shape of hollow organs including the upper airway and can provide real‐time cross‐sectional airway imaging during endoscopy . Our group has successfully used LR‐OCT to generate images in the upper airways of adults and pediatric patients , and developed methods to process LR‐OCT images into three‐dimensional (3D) reconstructions .…”

Real‐time robotic airway measurement: An additional benefit of a novel steady‐hand robotic platform

“…Other techniques utilizing videobronchoscopy and photodocumentation of the stenosis next to an instrument of known length can be unreliable in subjective real‐time qualitative assessment or require challenging postprocedure image analysis to provide quantitative data . Similarly, systems utilizing optical coherence tomography (OCT) can require complex data postprocessing with manual segmentation . Measurements with OCT, and similarly ultrasound, can also be limited by artifact and variability in image quality that can negatively impact resolution .…”

“…[10][11][12] Similarly, systems utilizing optical coherence tomography (OCT) can require complex data postprocessing with manual segmentation. 13 Measurements with OCT, and similarly ultrasound, can also be limited by artifact and variability in image quality that can negatively impact resolution. 13,14 As such, a system that can provide real-time quantitative airway measurements with a high level of accuracy has yet to be described.…”