Laryngo-tracheal anastomosis: Post-operative evaluation by helical CT and computerized reformations

Objective: Our purpose was to evaluate the role of post-operative helical computed tomography (CT) and computerized reformations in patients after laryngo-tracheal segmental resection with anastomosis. Methods: Helical CT and computerized reformations were obtained in 11 consecutive patients who underwent taryngo-tracheal resection with anastomosis for obstruction or stenosis caused by longstanding intubation or tracheostomy. Post-operative computer assisted cross-sectional area, coronal and sagittal diameter measurements at the level of maximal narrowing of the trachea were compared with clinical assessment in all patients. The additive value of various coronal and sagittal computerized reformations over axial images was subjectively evaluated by a consensus of a thoracic radiologist and a neuroradiologist who were blinded to clinical information. Results: Various degrees of restriction in daily activities were reported by patients with cross-sectional area narrowing of more than 50%, by 4/6 patients with cross-sectional area of less than 90 mm², by 4/5 and 4/6 patients with coronal or sagittal narrowing of more than 25% respectively, and by 4/5 patients with sagittal diameter of less than 12 mm. All five patients with cross-sectional area stenosis of less than 50% assessed themselves as 'asymptomatic'. Sagittal multi-planar and volume rendering reformations clarified or added additional information over axial images in all six patients with significant cross-sectional area stenosis (> 50%). Volume rendering scores were significantly higher than minimal intensity projection reformations (P = 0.01). Conclusion: Our preliminary results suggest that CT-based cross-sectional area and diameter measurements of the trachea represent a clinically helpful tool for post-operative evaluation of patients with tracheoplasty. The need for post-operative endoscopy may be obviated in some cases.