BRONCHIAL ANASTOMOTIC COMPLICATIONS IN LUNG-TRANSPLANT RECIPIENTS - VIRTUAL BRONCHOSCOPY FOR NONINVASIVE ASSESSMENT

PURPOSE: To compare the accuracy of virtual bronchoscopy (VB) with tha t of axial computed tomography (CT) in the assessment of bronchial ana stomotic complications in lung transplant recipients. MATERIALS AND ME THODS: Twenty-seven bronchial anastomoses in ii patients were evaluate d with helical CT. Axial CT and VB images were evaluated for surface i rregularity and the presence, length, and severity of stenosis. findin gs were correlated with the results of fiberoptic bronchoscopy (FOB). RESULTS: There were 12 anastomotic stenoses at FOE. Pooled accuracy (a mong all four readers) of VB and axial CT for diagnosis of clinically relevant stenosis was 97% and 80%, respectively, at the right bronchia l anastomoses and 92% and 75%, respectively, at the left bronchial ana stomoses. Pooled accuracy of VB and axial CT for stenosis length was 7 2% and 62%, respectively, at the right anastomoses and 81% and 69%, re spectively, at the left anastomoses. These differences were not statis tically significant. Both the VB and axial CT images showed surface ir regularities when anastomotic infection (n = 2)or dehiscence (n = 1) w as present but resulted in an overdiagnosis of mucosal abnormalities w hen anastomoses were normal. CONCLUSION: VB was slightly more accurate than axial CT for diagnosis of clinically relevant stenoses at bronch ial anastomoses in lung transplant recipients. However, because VB is not 100% accurate and has no role in the diagnosis of infection or deh iscence, it probably will not replace FOE for assessment of bronchial anastomotic complications in this population.