Lawson M Louise, Barnes-Eley Myra, Burke Bonnie L, Mitchell Karen, Katz Michael E, Dory Christopher L, Miller Stephen F, Nuss Donald, Croitoru Daniel P, Goretsky Michael J, Kelly Robert E
Center for Pediatric Research, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA, USA.
J Pediatr Surg. 2006 Jul;41(7):1219-25. doi: 10.1016/j.jpedsurg.2006.03.003.
In evaluating the impact of surgical repair of pectus excavatum, the Haller index developed for preoperative decision-making purposes may be inadequate to quantify postoperative changes in shape of the chest. Individual patients may also have chest characteristics that impact the success of repair, many of which would be unlikely to be measured by the Haller index alone. We have developed a protocol that measures the cross-sectional chest area and the asymmetry index along with the Haller index to more completely quantify the nature of the deformity. The purpose of this study was to determine the reliability of this protocol in the interpretation of chest computed tomography images from multiple sites. The protocol was developed as part of a multicenter study of clinical outcomes after surgical repair of pectus excavatum.
Two radiologists independently selected 5 images from each of 32 computed tomography scans from multicenter study participants according to the protocol. A digitizer was used to measure the diameters and cross-sectional areas of the images selected; these results were used to calculate the Haller and asymmetry indices. The protocol was tested for intradigitizer and interradiologist reliability. Using the Haller and asymmetry indices, we also assessed agreement between radiologists classifying patients as abnormal.
Agreement was uniformly high for all comparisons (all Lin's concordance coefficients >0.99 and all Cohen's kappa's >0.85, all agreement on classification of patients >95%) indicating almost perfect agreement. Disagreement on classification of patients using the Haller and asymmetry index was at the cut points for abnormality.
The protocol was found to be a highly reliable method for deriving the cross-sectional area of the chest and the Haller and asymmetry indices and for classifying patients for surgical eligibility. Borderline cases should be examined carefully to determine the appropriateness of surgical intervention. Cross-sectional area can be measured reliably using this protocol and thus may be useful in quantifying the success of surgical intervention.
在评估漏斗胸手术修复的影响时，为术前决策制定而开发的哈勒指数可能不足以量化术后胸部形状的变化。个体患者的胸部特征也可能影响修复的成功率，其中许多特征不太可能仅通过哈勒指数来衡量。我们制定了一种方案，该方案除了测量哈勒指数外，还测量胸部横截面积和不对称指数，以更全面地量化畸形的性质。本研究的目的是确定该方案在解读来自多个部位的胸部计算机断层扫描图像时的可靠性。该方案是漏斗胸手术修复术后临床结果多中心研究的一部分。
两位放射科医生根据该方案从多中心研究参与者的32份计算机断层扫描中，每份独立选择5张图像。使用数字化仪测量所选图像的直径和横截面积；这些结果用于计算哈勒指数和不对称指数。对该方案进行了数字化仪内和放射科医生间的可靠性测试。使用哈勒指数和不对称指数，我们还评估了放射科医生在将患者分类为异常方面的一致性。
所有比较的一致性均很高（所有林氏一致性系数>0.99，所有科恩kappa系数>0.85，所有患者分类的一致性>95%），表明几乎完全一致。使用哈勒指数和不对称指数对患者进行分类时的不一致出现在异常的切点处。
该方案被发现是一种高度可靠的方法，可用于得出胸部横截面积、哈勒指数和不对称指数，并对患者进行手术资格分类。临界病例应仔细检查，以确定手术干预的适宜性。使用该方案可以可靠地测量横截面积，因此可能有助于量化手术干预的成功率。
