News - Part 5

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Flexible bronchoscopy procedures

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Flexible bronchoscopy proceduresBecause virtual bronchoscopy has an interactive design, we used the multiview mode at the workstation in combination with axial CT scan slices and multiplanar reformats for analysis of the airways. This is particularly useful for orientation within the tracheobronchial tree, and permits differentiation between intraluminal tumor growth and extraluminal airway compression. Furthermore, axial and reformatted CT scan slices are an indispensable tool for thoracic CT diagnosis, providing important anatomic and pathologic information beyond the luminal view of a bronchoscope, and permitting the detection of adenopathy and neighborhood infiltration. http://naturalbreastenhancementpill.com/ Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Airway stenosis

Compared to the central airways, we found a higher rate of false-positive stenoses in the segmental bronchi. In our study, intraluminal mucus deposition caused more false-positive segmental airway readings (seven) than false-positive central airway readings (four). It has been reported that the segmental airways seem to be more susceptible to the deposition of mucus and coagulated blood, which can only be removed by irrigation and suction on flexible bronchoscopy. This may explain why we found a lower positive predictive value for segmental airway stenosis (40.9%) than for central airway stenosis (84.4%). alta white teeth whitening Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Discussion

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: DiscussionWe evaluated the success rate of noninvasive, multirow detector CT virtual bronchoscopy in detecting and grading central and segmental airway stenosis. In our present study, virtual bronchoscopy enabled high-resolution endoluminal imaging of the airways including segmental bronchi. Virtual bronchoscopy of segmental airway stenosis provides important additional information on the tracheobronchial tree and was not evaluated in earlier reports, where it has been applied exclusively for the detection of central airway stenosis. A preliminary study concluded that virtual bronchoscopy can render stenosis in anatomic detail, but that further studies were needed to evaluate its diagnostic potential. Other studies, have found virtual bronchoscopy to have a high sensitivity (> 90%) and specificity (> 98%) in detecting central airway stenosis in patients with bronchial carcinoma. The results of these studies were confirmed by our investigations, showing a sensitivity of 90% for detection of central airway stenosis. Additionally, we found a sensitivity of 90% for the detection of segmental airway stenosis, although the number of false-positive findings here was higher. Segmental airway stenosis had not been evaluated in any of the previously conducted studies. Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Analysis Per Patient

Nine findings were true-positive, and 13 were false-positive. The 13 false-positive findings were for the left upper lobar apicoposterior segmental bronchus (B I/II) [two patients], the left upper lobar anterior segmental bronchus (B III) [two patients], the right lower lobar superior segmental bronchus (B VI), the right upper lobar apical segmental bronchus (B I) [two patients], the right upper lobar posterior segmental bronchus (B II), the right upper lobar anterior segmental bronchus (B III), the left lower lobar anteromedial segmental bronchus (B VII/VIII), the right lower lobar medial basal segmental bronchus (B VII), the middle lobar medial segmental bronchus (B IV), and middle lobar lateral segmental bronchus (B V). In seven of the 13 false-positive stenoses, mucus was noted on flexible bronchoscopy, which was removed through irrigation and suction. One false-negative finding was made in the left lower lobe superior segmental bronchus (B VI). The sensitivity (90.0%), accuracy (95.5%), and negative predictive value (99.6%) of virtual bronchoscopy for the diagnosis of segmental airway stenosis were similar to those for the central airways. The positive predictive value, however, was lower for the segmental airways (40.9%) than for the central airways (84.4%). Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Central Airways

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Central AirwaysFlexible bronchoscopy revealed a total of 30 central airway stenoses. Thirteen stenoses were judged to be grade 1, and 17 were judged to be grade 2. Virtual bronchoscopy detected a total of 32 stenoses. Fourteen stenoses were judged to be grade 1, and 18 were judged to be grade 2. Figure 1 shows a grade 2 stenosis of the right main bronchus. Twenty-seven findings were true-positive, five were false-positive (ie, trachea, right upper lobe bronchus, intermediate bronchus, middle lobe bronchus, and left main bronchus), and three were false-negative (ie, right main bronchus, intermediate bronchus, and right lower lobe bronchus) [ Table 2]. In four of the five false-positive stenoses, mucus was noted on flexible bronchoscopy, which was removed through irrigation and suction. Virtual bronchoscopy had 95.5% accuracy, 90.0% sensitivity, and 96.6% specificity for the detection of central airway stenosis. The positive predictive value was 84.4%, and the negative predictive value 97.9%. Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: Statistical Analysis

The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of virtual bronchoscopy were calculated from 2 X 2 contingency tables, with confidence intervals derived from binomial distribution. A Fisher exact test was used to test for significance in field entries smaller than five where the x2 test was not applicable.
Assessments by virtual bronchoscopy were defined as overestimations or underestimations according to whether the particular stenosis was assigned a lower or higher grade on review of the findings of flexible bronchoscopy. The Spearman rank order correlation (r) was calculated to measure the strength of correlation between the results of virtual bronchoscopy and flexible bronchoscopy. A p value of < 0.05 was considered to be significant. Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: CT Scan Image Analysis

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: CT Scan Image AnalysisTable 1 shows the anatomic classification of the tracheobronchial tree, which was divided into 27 regions (9 central airway regions and 18 segmental airway regions). For image analysis, a virtual bronchoscopic fly-through of the tracheobronchial tree was performed in a central-to-peripheral direction by a fully board-certified radiologist specializing in chest radiology. For optimal orientation within the tracheobronchial tree and evaluation of the surrounding structures, virtual bronchoscopy was performed in the multiview mode in combination with dynamic axial and multiplanar reformatted imaging. The time for image analysis of a single patient ranged from 15 to 45 min. CT image analysis was performed in random order, and was blinded to flexible bronchoscopic findings and clinical history. Virtual bronchoscopy was evaluated using a flowsheet that listed all airways to the segmental level. For each airway region, the estimated grade of stenosis was recorded using a 3-point scale as follows: grade 0, no stenosis; grade 1, luminal narrowing of < 50%; or grade 2, luminal narrowing of > 50%. Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy: CT Scanning

Patients were only included if they had undergone both CT scanning and flexible bronchoscopy. The mean interval between virtual bronchoscopy and flexible bronchoscopy was 5.4 days (range, 0 to 17 days). Eventually, 17 of the 20 patients had lung cancer as the final diagnosis. Histologic diagnoses included non-small cell lung cancer (14 diagnoses) and small cell lung cancer (3 diagnoses). Because both procedures were performed in the context of patient care and were evaluated in retrospect, no institutional review board approval or patient informed consent had to be obtained, according to the guidelines of our institution. Read more »

Grading Airway Stenosis Down to the Segmental Level Using Virtual Bronchoscopy

Grading Airway Stenosis Down to the Segmental Level Using Virtual BronchoscopyNoninvasive imaging of the airways has made remarkable progress in the past decade. The introduction of multirow detector CT scanners has made it possible to acquire high-resolution images of the upper, central, and segmental airways within a short acquisition time. The CT scan data can be reformatted into three-dimensional images to create virtual bronchoscopic renderings that closely resemble the images obtained from flexible broncho-scopy. in detail Read more »

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Conclusion

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: ConclusionSpiration, Inc. (Redmond, WA) began a US Food and Drug Administration-approved clinical trial of vacuum-assisted lung reduction (VALR) in April 2002. The current elastomer sleeve under study is deployed with a button-activated introducer using gentle vacuum pressure to draw lung tissue into the sleeve (Fig 7). The sleeve applies radial compression via a band to the proximal lung tissue in the sleeve, sealing the compressed lung. Sutures are placed through the sleeve and the proximal compressed lung (Fig 8). The distal compressed lung and sleeve are removed, leaving a short cylinder of compressed lung on the surface. whitening gel Read more »

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