Dore Mariela, Triana Junco Paloma, Bret Monserrat, Gomez Cervantes Manuel, Muñoz Romo Martha, Jimenez Gomez Javier, Perez Vigara Ana, Parron Pajares Manuel, Luis Encinas Jose, Hernandez Francisco, Martinez Leopoldo, Lopez Santamaria Manuel, De La Torre Carlos
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Spain.
Eur J Pediatr Surg. 2018 Feb;28(1):34-38. doi: 10.1055/s-0037-1604427. Epub 2017 Jul 31.
Cardiac function can be impaired in patients with pectus excavatum (PE) due to anatomic and dynamic compression of the heart. Efforts for radiation dose reduction in imaging techniques have allowed cardiac magnetic resonance imaging (c-MRI) to play a major role in PE assessment. The aim of our study is to describe the findings of c-MRI 18 months after we changed the PE assessment protocol from chest computed tomography to c-MRI.
Since mid-2015 all patients with severe PE (suspected Haller's index > 3.2) were assessed with inspiratory and expiratory c-MRI. A retrospective analysis of these patients was performed evaluating the following parameters: (1) Radiologic PE indexes (Haller's, correction and asymmetry indexes; and sternal rotation) and (2) cardiac function (including left and right ventricle ejection fraction).
A total of 20 patients met the inclusion criteria. Dynamic imaging showed a significant difference during inspiration and expiration of the Haller's index 3.85 (range: 3.17-7.3) versus 5.10 (range: 3.85-10.8) ( < 0.05), and correction index (26.86% vs. 36.84%, respectively, < 0.05). The sternal rotation was 14.5 (range: 0-36). c-MRI analysis disclosed a right ventricle ejection fraction of 50.3%. (normal range: 61% [54-71%]). Echocardiographic imaging underestimated the functional repercussion of PE in all patients.
Initial results show that PE assessment by c-MRI allows a radiation-free image of the chest wall deformity during the entire breathing process. Also, it permitted the evaluation of the influence of sternum impingement on cardiac function. These findings allowed us a careful surgical evaluation and preoperative planning.
漏斗胸（PE）患者由于心脏受到解剖学和动力学压迫，心脏功能可能受损。成像技术中降低辐射剂量的努力使得心脏磁共振成像（c-MRI）在PE评估中发挥了主要作用。我们研究的目的是描述将PE评估方案从胸部计算机断层扫描改为c-MRI 18个月后的c-MRI检查结果。
自2015年年中起，所有重度PE患者（疑似哈勒指数>3.2）均接受吸气和呼气c-MRI检查。对这些患者进行回顾性分析，评估以下参数：（1）放射学PE指数（哈勒指数、矫正指数和不对称指数；以及胸骨旋转）和（2）心脏功能（包括左心室和右心室射血分数）。
共有20名患者符合纳入标准。动态成像显示，吸气和呼气时哈勒指数有显著差异，分别为3.85（范围：3.17 - 7.3）和5.10（范围：3.85 - 10.8）（P<0.05），矫正指数分别为26.86%和36.84%（P<0.05）。胸骨旋转角度为14.5（范围：0 - 36）。c-MRI分析显示右心室射血分数为50.3%。（正常范围：61%[54 - 71%]）。超声心动图成像低估了所有患者中PE对功能的影响。
初步结果表明，通过c-MRI进行PE评估可在整个呼吸过程中获得无辐射的胸壁畸形图像。此外，它还能评估胸骨压迫对心脏功能的影响。这些发现有助于我们进行仔细的手术评估和术前规划。
