Role of multislice computed tomography and virtual bronchoscopy in evaluation of pulmonary masses

Background
Multidetector computed tomography-generated virtual bronchoscopy (VB) is a recent technical development that allows visualization of the lumen and wall of the trachea and proximal part of the bronchial tree. A dynamic image is produced that resembles what is seen with fiberoptic bronchoscopy (FOB).


Patients and methods
This prospective study was conducted on 54 patients examined in National Cancer Institute, Radiology Department, between January 2017 and February 2020. All patients underwent both multidetector computed tomography and VB. We included patients with histologically proved lung cancer either by true-cut needle biopsy or FOB guidance. The local ethical committee had approved the study protocol, and the patients had given informed consent before the examinations.


Results
We detected 53 lesions by VB, whereas 56 bronchial lesions were detected by FOB. Two patients with findings of bronchial lesions on FOB had normal findings on VB. One patient had normal findings on both VB and FOB. Two patients with normal bronchial findings on FOB had a bronchial lesion according to VB (as the endobronchial masses were located distal to obstruction.


Conclusion
VB should be performed in cases with bronchial obstructing tumors owing to its ability to detect obstructive masses distal to high-grade stenosis and bypassing beyond the obstructing mass lesion to detect the distal changes beyond the tumor. Moreover, by adding multiplanar reformat (MPR), we can determine the extrabronchial part of bronchial mass and its actual size and can detect any other extrabronchial associated findings such as lymphadenopathies and metastases. Moreover, it can detect the etiology of the external compression and carinal widening.