الفهرس 
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Abstract
Multidetector computed tomography-generated virtual bronchoscopy (VB) is a novel computed tomography (CT)-based imaging technique which is a recent technical development that allows a noninvasive intraluminal visualization and evaluation of the lumen, wall and diameter of the trachea, the left and right main stem bronchi, and the bronchial tree down to the fourth order of bronchial orifices and branches. The morphology of the carinas can be evaluated accurately and the images look very similar to that seen with conventional bronchoscopy (fiberoptic or rigid).
The primary aim of this study is to evaluate the diagnostic accuracy of VB compared to the gold standard investigation of CB (fiberoptic or rigid) and the viability of its use by thoracic surgeons.
This work included 50 patients; 24 (48%) males and 26 (52%) females, their age ranged between 2 ys old &70 ys old with the mean age 44.1 ± 19.84. The number of smokers was 22 (44%) and non-smoker was 28 (56%). All of them were admitted to cardiothoracic surgery, chest diseases and pediatric departments, Benha university hospitals from October 2012 to October 2015. All patients were subjected to history taking, physical examination & radiological examination (Plain chest x-ray & Spiral CT scan of the chest). The data acquired after scanning were reconstructed then transferred to a workstation for VB. Conventional bronchoscopies were done in cardiothoracic surgery department, Benha university hospitals. The bronchoscopes used are fiberoptic bronchoscope (Olympus BF-1T60) & rigid bronchoscope (Storz, William pick). Reports were written for every case with full comment.
72
Review of literature
Summary
• (70%) of cases were FB aspiration (the most of cases).
• (28%) of FB aspiration were on the left side.
• The C.T. finding in (34%) of cases was pulmonary collapse that indicated VB to confirm diagnosis and causes.
• Both CB and VB were matched exactly in 35 cases with endobronchial FB aspiration.
• There was no significant difference between CB findings and VB findings using McNemar test in detecting endobronchial lesions.
• Agreement between CB and VB occurred in 9 cases of lung malignancy while disagreement occurred in 6 cases. Although the agreement was in presence of tumor masses, the disagreement was in the interpretation of the image of the mass.
• The results of VB were:
-4 cases of bronchial stenosis.
-2 cases of endobronchial tumor mass.
• The results of CB were:
-5 cases of bronchial stenosis.
-3 cases of endobronchial tumor mass. -One case of TOF.
The results of this study show that there was no significant difference between CB and VB in detection of FB aspiration, endobronchial tumor mass & subsequent bronchial obstruction, bronchial stenosis and extraluminal compression. VB detected tracheobronchial lesions with a sensitivity of (70.5%) and accuracy of (86.1%). There was (88%) agreement of both CB and VB in exclusion of endobronchial lesion so, VB could be used to exclude endobronchial lesion in cases unfit for CB.
73
Review of literature
Summary
VB is a valid diagnostic tool, suggesting that it can be used as a complementary investigation in the diagnosis and management of tracheobronchial airway disease. VB can add to the confidence level of the bronchoscopist by mapping out the tracheobronchial tree also provides a road map for bronchoscopy as a guide for transbronchial biopsy and for endobronchial treatment planning and also can be used in the postoperative follow-up both for cancer and transplant.
VB will not replace CB because direct airway visualization has remained the gold standard and has generally achieved at low cost risk, with definitive results, VB is useful as a pre-procedure guide to bronchoscopy by providing excellent anatomy of the airway.