Although SHR-CT scanning and VB presently cannot be utilized for the identification of preneoplastic lesions, these imaging modalities have a tremendous potential for clinical application. SHR-CT scanning and VB are noninvasive. The radiation exposure associated with these scans is comparable if not less than that of conventional CT scans of the chest. SHR-CT scanning and VB provide unique opportunities to assess extraluminal and intraluminal airway pathology by allowing visualization from multiple angles. Thus, highly effective, objective, and reproducible investigation of poststenotic regions beyond the reach of endoscopy with either SHR-CT scanning or VB is possible. As these modalities provide accurate information regarding tracheobronchial anatomy, SHR-CT scanning and VB may become invaluable for assessing the feasibility of resections as well as laser or photodynamic ablations of airway stenoses.
Our data indicate that SHR-CT scanning and VB are powerful, objective, and reproducible imaging modalities that can complement FB for the evaluation of tracheobronchial malignancies. As such, we propose the following algorithm for patients who are at high risk for airway pathology (Fig 4). Asymptomatic patients should undergo screening using conventional chest CT scans. Symptomatic individuals should undergo SHR-CT scans. If abnormalities are detected, VB can be used to further define and simulate airway anatomy before FB or surgery. This algorithm may limit the number of unnecessary SHR-CT scans and 3-D VB reconstructions while optimizing the decisions regarding appropriate therapeutic interventions with curative or palliative intent. Follow-up SHR-CT scans and VB would enable the serial evaluation of the treatment response in these individuals. Here
Wise for data management, and Donald Bliss and Alan Hoofring for original medical illustration.
Emerging technologies often precede advances in patient care. As clinicians, we must justify the indications for novel, potentially expensive medical procedures. This study demonstrates that SHR-CT scanning and VB are accurate, noninvasive methods for evaluating obstructions, endoluminal masses, and poststenotic areas within the airway. These novel imaging modalities provide information regarding bronchial and peribronchial anatomy that may prove beneficial in the management of patients with thoracic malignancies.
Figure 4. Algorithm utilizing CT scanning, SHR-CT scanning, and VB for patients who are at high risk for airway pathology.