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CT Accurate for Assessment of Airway Stents

February 6, 2009
Written by: , Filed in: Chest Radiology, Interventional Radiology
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The objective of a recent study was to evaluate how well CT detects airway stent complications compared with bronchoscopy.

The results have shown that CT is accurate for identifying airway stent complications such as stent fracture, stent migration, significant stent luminal narrowing, stent neoplastic invasion, and airway perforation.

Design
Retrospective study.

Participants
Twenty-one patients who had airway stent complications proven by bronchoscopy and had also undergone CT within one week of bronchoscopy.

Methodology
Three stents were tracheal, 7 were tracheobronchial, and 11 were bronchial. Thirteen patients had stents placed for benign conditions, and 8 had stents placed for malignant conditions. Benign conditions included tracheobronchomalacia, post-intubation stenosis, sarcoidosis, and stenosis due to kyphoscoliosis.

Eleven stents were metallic and 10 were silicone. CTs were performed on an 8-MDCT scanner and used 2.5-mm collimation. Coronal and sagittal multiplanar reformatted images and three-dimensional internal and external rendered images were obtained as well.

On CT, stents were evaluated for stent fracture (discontinuity of stent wall), stent migration, stent lumen narrowing (>25% loss of cross-sectional area due to internal soft tissue density), stent neoplastic invasion (contiguous spread of tumor into airway through stent), airway perforation (extraluminal air collection), and stent erosion into nearby structures.

All patients also underwent flexible bronchoscopy using standard technique. For this study, bronchoscopy was considered the reference standard.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging

Results
Thirty complications were seen at bronchoscopy; 13 (43%) had stent lumen narrowing, 9 (30%) had stent migration, 4 (13%) had stent fracture, 3 (10%) had stent neoplastic invasion, and 1 (3%) had tracheal perforation. On MDCT, the abnormality was seen in 29 of 30 cases (97%).

One case of stent fracture was missed on CT involving a metallic stent. This abnormality could also not be seen on retrospective review of CT axial images and reconstructions.

Conclusions
CT is very accurate for identifying airway stent complications.

Reviewer’s Comments
The authors have demonstrated the utility of CT in assessing airway stents. They acknowledge that since this study examined only patients with bronchoscopically proven stent complications, the study may be biased toward more severe stent complications.

Author: Vineet R. Jain, MD

Reference:
Dialani V, Ernst A, et al: AJR Am J Roentgenol; 2008;191 (November): 1576-1580:
MDCT Detection of Airway Stent Complications: Comparison With Bronchoscopy.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging
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