Thoracic Imaging 2003 - Society of Thoracic Radiology

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THURSDAY 268 threshold values for surface rendering techniques have been described by Summers as –500. While these thresholds are effective in the main and lobar bronchi, artifacts can occur in the smaller airways, and may also result in a overestimation of stenoses. Faster reconstruction times have made volume rendered techniques more accessible are are used increasingy at our institution. As we have seen with more recent literature in virtual colonscopy, an original fascination with the technology has given way to a more realistic assessment of VBs particular capabilities and weaknesses. One of the greatest strengths of virtual bronchoscopy is the added benefits inherent in CT imaging. Unlike fiberoptic bronchoscopy, the data used in the generation of the virtual bronchoscope is not limited to the lumen: CT bronchosocpy has the ability to accurate depict extraluminal anatomy not available to the bronchoscopist Integration of this intraluminal and extraluminal data will be discussed later. Many of the imaging limitations of virtual bronchoscopy have been well defined by Summers, but often describe the markedly limited ability of the virtual bronchoscope to depict mucosal abnormalities. The unavoidable integration of cardiac and respiratory motion into the virtual bronchoscope introduces subtle error into the depiction of VB data and therefore limits the ability to evaluate the mucosal and submucosal pathology. A number of papers have been written comparing the diagnostic value of virtual bronchoscopy with standard CT images as well as fiberoptic bronchoscopy. One of the values of virtual endoscopy in the airways is the evaluation of the upper airways. In a paper by Burke, Vinings and others using FreeFlight software,, evaluation of airway obstruction was evaluated using virtual bronchosocpy. This study included 30 patients with upper airway disease ranging from airway stenosis, laryngtracheomalacia, tumors and webs. There was excellent agreement betweenVB and FOB is the evaluation of airway stenoses. The differences in ratios of stenoses/lumen was within 10% for VB vs upper airway endoscopy. The evaluation of dynamic airway collapse was much less reliable with virtual endoscopy, but there was clearly established a role for virtual endoscopy in airway stenoses. Several papers have been written defining the role of virtual bronchoscopy in patients with airway stenoses secondary to bronchogenic carcinoma. In the paper by Liewald et al, 30 patients with bronchogenic carcinoma were studied. While central lesions were well identified by virtual bronchosocpy, stenosis secondary to smaller lobar lesions were not accurately identified. In a paper by Rapp Bernhardt , a number of visualization thecniques were compared, includeing axial, MPR, MinIp and virtual bronchoscopy Virtual bronchosocopy evaluation of stenoses showed the lowest interobserver variability. There was no significant difference between virtual and fiberoptic bronchoscopy in the estimation of stenoses, though there tended to be some overestimation of stensos, felt to be due to thresholding limitationsof stenoses in virtual bronchoscopy Mucosal abnormalies were not well evaluated with virtual bronchscopy. Other work has looked at the success of bronchial stenoses in a lung transplant population. In this paper, stenoses at the anastomosis was evaluated by axial and virtual bronchosocpy. Stenoses at the anastomotic sites were better visualized by virtual bronchoscopy than axial CT, though this was not statistically significant. Surface irregularties due to infection were equally visualized with virtal and fibeeroptic bronchoscopy. There is an increasing literature on the use of virtual bronchscopy in improving the diagnostic accuracy of fiberoptic bronchoscopy. In a paper by McAdams, the virtual bronchoscopy was reviewed by the pulmonologist for evaluation of lymph node node biopsy, and was preferred to the axial CT slices. There was a slight improvement in diagnostic yield compared to standard axial images when VB images were reviewed. In a paper by Hopper, a technique of lymph node highlight was described. Mediastinal lymph nodes were manually segmented and highlighted and iintegrated into the surface rendered virtual bronchocopy. By the use of varying the transparency of the bronchial wall, the involved lymph node could be chosen before the procedure. While there was no significant difference in the diagnostic sampling of subcarinal lymph nodes, these techniques improved diagnostic yield significantly for hilar and pretracheal lymph nodes. We have used virtual endoscopy in the chest to also evaluate the esophagus and aorta. Virtual endoscopy has been used extensively by our thoracic surgeons to preoperatively assess the aorta. Evaluation of atherosclerotic disease, endoscopic evaluation of dissections, aneurysms and stenoses have helped the presurgical planing of pulmonary thromboendarterectomy. It has been used in the coronary arteries, and pulmonary arteries for evaluation of stenoses and embolic disease. As our techniques improve, virtual endoscopic techniques will only improve, as will their clinical applications. REFERENCES: Haponik E, Acquino S, Vining D, Virtual Bronchoscopy Clinics in Chest Medicine 20;201-217 1999 Burke A, Vining DJ, McGuirt W, et al Evaluation of airway Obstruction Using Virtual Bronchoscopy. Laryngosocope;110 23-29 2000 McAdams N, Palmer s, Erasmus JJ et al. Bronchial Anastomotic Complications in Lung Transplant Recipients:Virtual Bronchoscopy for Noninvasive Assessment Radiology 1998;209:689-695 Hopper K, Lucas TAS, Gleeson K, et al. Transbronchial Biopsy with Virtual CT Bronchoscopy and Nodal Highlighting. Radiology 2001;221:531-536. Seeman M, Claussen C, Hybrid 3D Visualiztion of the chest and virtual endoscopy of the tracheobronchial system:possibilities and limitations of clinical application. Lung Cancer 32 (2001)237-246 .Rapp-Bernhardt U. Welte T, Doerhing W, et al Diagnostic potential of virtual bronchoscopy:advantages in comparision with axil CT slices, MPR and mIP. Eur. Radiol.10,981-988 (2000).
Notes 269 THURSDAY
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The Society of Thoracic Radiology T
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Dear Friends, Welcome to Miami Beac
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Continuing Medical Education Credit
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Warren B. Gefter, MD University of
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Ernest M. Scalzetti, MD SUNY Upstat
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Registration Hours Saturday, March
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Program Committee Ella A. Kazerooni
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Small Airway Disease Americana 3 Mo
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Benjamin Felson Memorial Lecture Am
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Session 2-B Concurrent Session Clin
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Workshops (choose 1) 1:00 - 1:45 D1
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Sunday
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March 2, 2003 General Session Sunda
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SUNDAY 46 One type of direct-readou
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CT-PET Imaging Suzanne Aquino, M.D.
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SUNDAY 58 an accompanying decreased
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SUNDAY 60 Radiofrequency Ablation i
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SUNDAY 62 17. Sewell PE, Vance RB.
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SUNDAY 64 cal ventilation will be r
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SUNDAY 66 radiologic, and histopath
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SUNDAY 68 application. The untreate
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SUNDAY 70 The Expanded Spectrum of
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SUNDAY 72 Hypersensitivity Pneumoni
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SUNDAY 74 Small Airway Diseases Mic
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SUNDAY 76 The “Head-cheese Sign
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SUNDAY 78 “Holes” in the Lung:
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SUNDAY 80 Pleural Effusions Gerald
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SUNDAY 82 Asbestos Related Pleural
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SUNDAY 84 Other Pleural Neoplasms S
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SUNDAY 86 Image-Guided Therapy of M
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Notes 88
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March 3, 2003 General Session 7:00
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Cardiac MRI: Established Indication
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Cardiac MRI: New Developments Gauth
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5. The volume of contrast medium re
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Acute Aortic Syndrome Ernest M. Sca
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as well as separation of the cusps
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Pulmonary Veins: Imaging for Radiof
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Imaging of Cardiopulmonary Support
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plied to the hollow fibers by an ex
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swelling of the entire leg, calf sw
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Multi-channel Pulmonary CTA: New Te
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terminate scintigrams, CT correctly
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CT Strucural and Functional Imaging
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curves (TDCs) are generated by manu
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7. Crawford T, Yoon C, Wolfson K, e
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80. Fleischmann D, Rubin GD, Bankie
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127 MONDAY
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129 MONDAY
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REFERENCES Bergin CJ, Rios G, King
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Notes 134
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March 4, 2003 General Session 7:00
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Adult Manifestations of Congenital
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will usually display the limbs of t
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Imaging of the Pericardium Paul L.
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Cardiomyopathy Martin J. Lipton, M.
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TUESDAY 150 Nuclear Cardiology Upda
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TUESDAY 152 ties. The predominant 1
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TUESDAY 154 Imaging protocols: Util
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Manpower Shortage in Radiology: Sol
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159 TUESDAY
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161 TUESDAY
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163 TUESDAY
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NIBIB Update for Thoracic Radiology
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vertically along the right atrium t
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Multidetector Pediatric Chest CT: P
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The Spectrum of Pulmonary Infection
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Immune deficiency occurs frequently
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TUESDAY 180 The Internet and the Pr
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TUESDAY 182 Workshop A1: Lymphoma:
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TUESDAY 184 Digital Images: Camera
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TUESDAY 186 Analysis of Mediastinal
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Unusual Manifestations of Lung Canc
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Page 149 and 150: March 5, 2003 General Session Wedne
Page 151 and 152: WEDNESDAY 208 principle is that “
Page 153 and 154: WEDNESDAY 210 years and a current o
Page 155 and 156: WEDNESDAY 212 lesions generally mim
Page 157 and 158: WEDNESDAY 214 capable of studying t
Page 159 and 160: WEDNESDAY 216 Small T1 Lung Cancer:
Page 161 and 162: WEDNESDAY 218 REFERENCES Seely JM,
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Page 169 and 170: Metastatic Disease to Lung Gordon L
Page 171 and 172: Thoracic Metastates from Osteosarco
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Page 177 and 178: WEDNESDAY 236 Pulmonary Arterial Hy
Page 179 and 180: WEDNESDAY 238 pathological process,
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Page 183 and 184: THURSDAY 250 Pulmonary Tuberculosis
Page 185 and 186: THURSDAY 252 1. Clinical criteria:
Page 187 and 188: THURSDAY 254 AIDS patients are also
Page 189 and 190: THURSDAY 256 Viral Infection on HRC
Page 191 and 192: THURSDAY 258 Imaging of Coccidioido
Page 193 and 194: THURSDAY 260 from the laryngeal sur
Page 195 and 196: THURSDAY 262 Inflammatory Diseases
Page 197: Virtual Endoscopy in the Thorax: Pr
Page 201: SECOND LEVEL THIRD LEVEL
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