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Ann Thorac Surg 1995;60:30-31
© 1995 The Society of Thoracic Surgeons
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Introduction |
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 Top Introduction |
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DR THOMAS R. J. TODD (Toronto, Ontario, Canada): That was very nice; those are very beautiful pictures. I think that the major advantage of the helical CT and the subsequent reconstruction over standard CT is not going to be so much defining the external extent of the growth or the stricture, because we are going to get that from a standard CT, but rather in more accurately delineating the length of involved airway as you plan for subsequent surgical intervention. The gold standard for that is clearly, I would think, bronchoscopic evaluation and measuring of the airway. Did you compare the actual length of airway involvement on helical CT versus what you obtained by accurate measurements of the involvement at rigid bronchoscopy?
DR WHYTE: That is a very good question, and we did try to do that. In some cases we were able to correlate the bronchoscopic length of stenosis with the radiographic length. This was easiest when either myself or one of my partners did the bronchoscopy. In some cases we relied on the bronchoscopy of a pulmonologist, or in one or two cases an otolaryngologist, and at times the actual length of stenosis was not always well recorded. Consequently, I confined the statistical analysis to what we could determine accurately, this being the degree of airway stenosis. I think that the position of the stenosis is fairly clear from most of the studies. Unfortunately, in some cases the data are incomplete, but there is no way one can go back and complete them.
DR L. PENFIELD FABER (Chicago, IL): A previous presentation at this meeting extolled the virtues of the positron emission tomographic scanner for the staging of lung cancer, and I would imagine this is a very expensive piece of equipment. If we purchase a positron emission tomographic scanner, can we well afford a helical CT scan to evaluate three or four tracheal problems a year? Unfortunately, our institution does not have this type of CT scanning equipment and as you so clearly pointed out, standard tomography is no longer available in many radiology departments. In the of face inadequate standard tomograms, we used the standard CT scan to evaluate tracheal pathology. However, it was not totally satisfactory in providing conceptual relationships for the planning of the length of a tracheal resection and indicating the necessity of a possible laryngeal release. We therefore started to use magnetic resonance imaging, which provides frontal, sagittal, and transverse sections all on one examination. Magnetic resonance imaging clearly shows the length of the tracheal stricture, the length of a tumor, and involvement in the paratracheal tissues and provides a clear concept of the required surgical resection. For those of you who do not have a helical CT scan, I would recommend magnetic resonance imaging for tracheal pathology. Doctor Whyte, do you have any experience with magnetic resonance imaging for tracheal examination, and has it been compared with the helical CT scan?
DR WHYTE: Thank you for your comments, Dr Faber.
In short, the answer is no, we have not used magnetic resonance imaging in the evaluation of these patients. I have spoken to my radiologic colleagues and they tell me that the helical CT scanner is becoming increasingly common. I think we have had the helical scanner in our institution for about a year now, and clearly the use of conventional tomograms is going down. I would be pleased to have a look at magnetic resonance imaging, but, as yet, we have not had experience using this technique in this situation.
DR JOHN R. BENFIELD (Sacramento, CA): We are fortunate enough to have helical CT scan available, and I thought I might share with you a recent experience in which I was asked to evaluate a difficult chest wall sternal problem. Plain radiographs and standard CT scans of the sternum are notoriously difficult to interpret, and they were not helpful. Helical CT scanning of the sternum resulted in spectacular pictures that resolved the questions.
DR THOMAS M. EGAN (Chapel Hill, NC): I enjoyed your presentation.
At our institution the tomogram table was removed more than a year ago and we have been forced to rely on spiral CT and reconstruction for evaluating airway problems, including stenosis after lung transplantation. One of the interesting developments, which perhaps we will have a chance to share with you here next year, has been the development of a computer program that digitizes all of these three-dimensional pixels, and now we actually can perform virtual bronchoscopy on a computer screen by taking the three-dimensional image and rotating it around and literally driving down through the center of the airway. For certain problems where three-dimensional appreciation of the anatomy is important, that has been a tremendous advance.
DR WHYTE: Doctor Egan, thank you for your comments. I agree with you; I think it is remarkable what the computers and mathematicians can do with these data now. It is really quite impressive.
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