Related Experiment Video
Updated: May 5, 2026
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Multi-modal Pulmonary Imaging: Using Complementary Information from CT and Hyperpolarized 129Xe MRI to Evaluate Lung Structure-Function
Published on: April 12, 2024
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Distinguishing Tracheobronchomalacia and Excessive Dynamic Airway Collapse on Dynamic CT Images.
Paolo de Angelis1, Jae Cho, Martina Rama
1Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA.
Summary
Clinicians struggle to differentiate expiratory central airway collapse (ECAC) causes like anterior displacement of the posterior membrane (EDAC) and tracheobronchomalacia (TBM). Early multidisciplinary evaluation is recommended for patients with ECAC.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Radiology
Background:
- Expiratory central airway collapse (ECAC) encompasses anterior displacement of the posterior membrane (EDAC) and tracheobronchomalacia (TBM).
- Accurate differentiation between EDAC and TBM is clinically challenging, potentially leading to misdiagnosis.
- Computed tomography (CT) imaging is crucial for diagnosing ECAC pathologies.
Purpose of the Study:
- To evaluate the accuracy of clinicians in identifying EDAC and TBM on CT images.
- To assess inter-rater agreement among physicians diagnosing ECAC.
Main Methods:
- Review of CT images from 100 patients who underwent tracheobronchoplasty (TBP).
- Four airway experts categorized images into TBM, EDAC, normal, or unknown.
- Selected TBM (n=9) and EDAC (n=9) images were distributed to 70 respondents (35 surgeons, 35 pulmonologists).
- Linear regression analyzed accuracy; Fleiss' kappa (κ) measured inter-rater agreement.
Main Results:
- Overall diagnostic accuracy was low, with only 1.5% of respondents correctly diagnosing all 18 cases.
- Inter-rater agreement was poor (κ=0.21).
- Higher accuracy was associated with more than 10 years in practice (β=0.49, P=0.03) and practicing pulmonology (β=0.72, P=0.02).
Conclusions:
- Distinguishing between EDAC and TBM on CT images is difficult for clinicians.
- Poor inter-rater agreement highlights diagnostic challenges in ECAC.
- Early referral for multidisciplinary evaluation is advised for patients with ECAC.
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