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Original Research: INTERVENTIONAL PULMONOLOGY |

Comparison of Dynamic Expiratory CT With Bronchoscopy for Diagnosing Airway Malacia*: A Pilot Evaluation

Karen S. Lee, MD; Maryellen R. M. Sun, MD; Armin Ernst, MD, FCCP; David Feller-Kopman, MD, FCCP; Adnan Majid, MD; Phillip M. Boiselle, MD, FCCP
Author and Funding Information

*From the Center for Airway Imaging, Department of Radiology, and Division of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Boston, MA.

Correspondence to: Armin Ernst, MD, FCCP, Division of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: aernst@bidmc.harvard.edu



Chest. 2007;131(3):758-764. doi:10.1378/chest.06-2164
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Objective: To assess the accuracy of dynamic expiratory CT for detecting airway malacia using bronchoscopy as the diagnostic “gold standard.”

Materials and methods: A computerized hospital information system was used to retrospectively identify all patients with bronchoscopically proven airway malacia referred for CT airway imaging at our institution during a 19-month period. CT was performed within 1 week of bronchoscopy. All patients were scanned with a standard protocol, including end-inspiratory and dynamic expiratory volumetric imaging, using an eight-detector multislice helical CT scanner. For both CT and bronchoscopy, malacia was defined as ≥ 50% expiratory reduction of the airway lumen. CT and bronchoscopic findings were subsequently jointly reviewed by the radiologist and bronchoscopist for concordance.

Results: Twenty-nine patients (12 men and 17 women; mean age, 60 years; range, 36 to 79 years) comprised the study cohort. CT correctly diagnosed malacia in 28 of 29 patients (97%). The most common presenting symptoms were dyspnea in 20 patients (69%), severe or persistent cough in 16 patients (55%), and recurrent infection in 7 patients (24%). The estimated radiation dose (expressed as dose-length product) for the dual-phase study is 508 mGy-cm, which is comparable to a routine chest CT.

Conclusion: Dynamic expiratory CT is a highly sensitive method for detecting airway malacia and has the potential to serve as an effective, noninvasive test for diagnosing this condition.

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