Low-dose volumetric CT using 40 to 80 mA is comparable to standard higher- Reprint requests to: publications@acr.org Tracheobronchial Disease dose techniques in demonstrating degree of trachea collapse [16], and low-dose techniques have been widely adopted for dynamic expiratory imaging assessment of ECAC [17,18]. Optimal evaluation of the airways requires thin-section imaging with a slice thickness of 1.5 mm or thinner. Larger slice thicknesses cause partial volume averaging that can obscure airway anatomy and airway lesions. Adequate breath holding at inspiration is also important, because respiratory motion can also obscure airway lesions and can also cause an erroneous impression of bronchiectasis caused by volume averaging and image blurring. OR Discussion of Procedures by Variant Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging. CT Chest With IV Contrast Chest CT is widely used for first-line imaging evaluation of central airway pathology such as masses, thickening, and stenosis. CT with intravenous (IV) contrast provides the advantage of evaluation of enhancement characteristics and optimal evaluation of hilar and mediastinal adenopathy [19], however, relevant studies comparing contrast- enhanced CT with unenhanced CT are lacking. CT has shown a high correlation with findings at bronchoscopy and offers additional advantages by depicting degree of stenosis, extraluminal involvement of lesions, and extension to adjacent structures [19-21]. CT allows assessment of the location, shape, dimensions, mural extent, and attenuation characteristics of tumors of the large airways and detection of intrathoracic disease in cases of malignancy [19,20]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of chest CT without and with IV contrast in the initial evaluation of suspected tracheal stenosis.
Tracheobronchial Disease. Low-dose volumetric CT using 40 to 80 mA is comparable to standard higher- Reprint requests to: publications@acr.org Tracheobronchial Disease dose techniques in demonstrating degree of trachea collapse [16], and low-dose techniques have been widely adopted for dynamic expiratory imaging assessment of ECAC [17,18]. Optimal evaluation of the airways requires thin-section imaging with a slice thickness of 1.5 mm or thinner. Larger slice thicknesses cause partial volume averaging that can obscure airway anatomy and airway lesions. Adequate breath holding at inspiration is also important, because respiratory motion can also obscure airway lesions and can also cause an erroneous impression of bronchiectasis caused by volume averaging and image blurring. OR Discussion of Procedures by Variant Variant 1: Adult. Clinically suspected tracheal or bronchial stenosis. Initial imaging. CT Chest With IV Contrast Chest CT is widely used for first-line imaging evaluation of central airway pathology such as masses, thickening, and stenosis. CT with intravenous (IV) contrast provides the advantage of evaluation of enhancement characteristics and optimal evaluation of hilar and mediastinal adenopathy [19], however, relevant studies comparing contrast- enhanced CT with unenhanced CT are lacking. CT has shown a high correlation with findings at bronchoscopy and offers additional advantages by depicting degree of stenosis, extraluminal involvement of lesions, and extension to adjacent structures [19-21]. CT allows assessment of the location, shape, dimensions, mural extent, and attenuation characteristics of tumors of the large airways and detection of intrathoracic disease in cases of malignancy [19,20]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of chest CT without and with IV contrast in the initial evaluation of suspected tracheal stenosis.