Role of Multi-Slice Computed Tomography Virtual Bronchoscopy and Multiplanar Reformatting in Evaluation of Post-Intubation Laryngotracheal Stenosis

Abstract

Background: Accurate assessment of stenosis site, degree, and length in post-intubation laryngotracheal stenosis patients is crucial for procedure selection and prognosis prediction. Despite being preferred method, bronchoscopy has its drawbacks in severely ill patients, with potential complications and limitations in evaluating airway features beyond high-grade stenosis. Computed Tomography (CT) scans with multiplanar reconstructions are suggested as a safer and alternative diagnostic tool to overcome these limitations. The present work aimed to compare diagnostic performance of CT virtual bronchoscopy (VB) and multiplanar reformatting (MPR) with conventional bronchoscopy (CB) in post-intubation laryngotracheal stenosis patients.Subjects and methods: This prospective comparative study, involved 30 patients with post-intubation laryngotracheal stenosis from October 2020 to October 2022. All patients underwent detailed history taking, thorough clinical examination, and endoscopic and radiological investigations. All patients underwent CT examination, rigid bronchoscope, and underwent tracheal resection anastomosis operation. The evaluated parameters were the length, diameter, cranio-caudal extent of stenosis in all settings, and the results were comparedResults: Regarding conventional bronchoscopy and crico-tracheal resection, a statistically significant difference in lumen diameter (p-value = 0.048) was noted. No significant difference in length (p-value = 0.943). No statistically significant difference (p-value = 0.951) as regards cranio-caudal extent.CT multiplanar reformatting and virtual bronchoscopy offer an accurate, noninvasive assessment of laryngotracheal stenosis, surpassing conventional bronchoscopy. They prove beneficial for precise lesion length and lumen diameter evaluation, especially beyond high-grade stenosis, where conventional bronchoscopy faces limitations. These techniques serve as dependable alternatives for patients at risk for anesthesia, providing a safer diagnostic approach