Maria Shiau,
a Department of Radiology, Center for Biological Imaging, New York University-Langone Medical Center, 660 1st Avenue, New York, NY 10016, USA
b Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
Despite the introduction of a wide range of imaging technologies over the past decade, including MRI and 18F-fluorodeoxyglucose (FDG) PET, computed tomography (CT) remains the most accurate noninvasive means for evaluating the central airways. There is a wide range of pathologic entities, both malignant and benign, for which CT imaging represents an essential component of both diagnosis and management. Indications for CT are generally in one of 2 broad categories: (1) symptomatic patients presenting with chronic cough, localized wheezing dyspnea, or hemoptysis, especially those with normal or nonlocalizing radiographs; and (2) cases in which there is endobronchial obstruction with or without associated atelectasis for which interventional bronchoscopic procedures are indicated, including for preprocedural planning as well as for postprocedural monitoring.1 and 2
This article will first review optimal CT techniques for imaging the central airways. Following this, a classification of central airway disorders is presented with select illustrative examples. The central airways are defined as those airways that may be directly visualized by flexible bronchoscopy: the trachea, mainstem and lobar airways, as well as proximal segmental bronchi. A detailed description of central airway anatomy is not presented because this topic has previously been extensively reviewed.3 In addition, emphasis is placed on CT-bronchoscopic correlations, in particular as pertains to both diagnostic and therapeutic interventional bronchoscopy.