Role of multi detector computed tomography and virtual bronchoscopy in evaluation of pulmonary neoplasms

Objectives: The aim of this study was to evaluate the accuracy of Mlti detector CT with multiplanar reconstruction images, virtual bronchoscopy [VB] and volume rendering technique compared to the results of fiber-optic bronchoscopy [FOB] in defining bronchial pathologies in patients with pulmonary neoplasms

Methods: Fifty four patients with symptoms or chest X-ray abnormality raising the suspicion of pulmonary neoplasm in which FOB and CT chest were ordered for the initial investigation. Patients underwent both FOB and MDCT

Results: Fifty four patients were enrolled in the study [including 41 with an endobronchial lesion at FB] the sensitivity and specificity of VB to detect endobronchial lesions were 100% and 86.7% respectively [95% CI]. The positive and negative predictive values of VB were 95.3% and 100% respectively. The accuracy was 962%. Overall, the agreement between VB and FOB regarding the location on endobronchial lesions was perfect [weighted kappa: 0.9]. In 12 cases with obstruction of the main bronchi [5 in left main, 7 in right main bronchus], VB is able to bypass beyond the mass level in 4 cases [33.3% of cases]. The FOB was able to bypass beyond the mass lesion in only 2 cases [16.7% of cases], both of them were partially obstructing masses. FOB cannot by pass beyond the mass level in any case with totally obstructing mass. As regard to the extrabronchial structures evaluation, 34 of the 41 endobronchial lesions were associated with extrabronchial part of the endobronchial lesion [ratio about 63% of cases]. The FOB was not able to detect the extra-bronchial lesions in any case. In evaluating extrinsic compressions of the airway, FOB detected 11 lesions; VB+MPR [multi planar reconstruction] detected 10 lesions [5 of them caused by enlarged LNS, the remaining 5 were caused by extrabronchial soft tissue mass], VB could not see one of the external compressions with sensitivity, specificity 90.0% and 97.6% respectively. Curved planar reformation detected 13 lesions with sensitivity, specificity 90.9% and 95.3% respectively. Volume rendering detected 12 lesions with sensitivity, specificity 100.0% and 97.7% respectively. While FOB detected 4 mucosal lesions, VB cannot detect any of them with sensitivity and specificity 0%

Conclusion: VB is an extremely useful modality for evaluation of bronchial lesions, it is noninvasive, and the ability to examine 2D and 3D anatomic detail from multiple directions enables precise assessment of intraluminal, extent of the extraluminal diseases or airway patency distal to high-grade bronchial stenosis. We concluded that multi-slice CT in connection with VB became an essential complementary to FOB in selected patients with bronchial lesions

Evaluation of renal functions using isotopic renogram and biochemical tests

Radionuclide renography is now very important diagnostic tool comparable to other diagnostic modalities for the evaluation of renal diseases. This study was carried out to assess the role of radionuclide renography and biochemical test in the evaluation of the renal function. A total of 50 samples with a history of renal disease were included in this study. Out of a total 50, 31 were males and 19 were females, their age ranged between 9 and 79 years and most of the patients were in the age group above 46 years, weight ranged from 22 to 97 kg, mean [standard deviation [SD]] 67.32 [17.203]. Height ranged from 125 to 185 cm, mean [SD] 163.07 [12.573]. Radionuclide renography and biochemical test were done for all patients in the Radiation and Isotope Center of Khartoum in the period from March 2011 to October 2011. In case of radionuclide renography, total glomerular filtration rate [GFR] ranged from 6.64 to 130.70, mean [SD] 65.87 [31.30] and the biochemical test showed that [10%] of patients with abnormal serum creatinine level and [12%] with abnormal serum urea level. The serum urea level was normal in 44 patients, but in the renogram 19 patients were abnormal [both kidneys GFR], 14 patients were abnormal [right kidney GFR] and 8 patients were abnormal [left kidney GFR]. A total of 45 patients had normal serum creatinine level, but in the renogram 18 patients were abnormal [both kidneys GFR], 16 patients were abnormal [right kidney GFR] and 8 patients were abnormal [left kidney GFR]. It is concluded that both isotopes renogram technique and biochemical test are very important in the evaluation of renal function