Giraudo Chiara, Nistri Francesca, Ferrigno Pia, Dolci Giampiero, Stramare Roberto, Guglielmi Giuseppe, Mammana Marco, Quaia Emilio, Giunta Domenica, Dell'Amore Andrea, Rea Federico
Radiology Institute, Department of Medicine - DIMED, University of Padova, Padova, Italy.
Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, University of Padova, Padova, Italy.
Quant Imaging Med Surg. 2021 Feb;11(2):502-509. doi: 10.21037/qims-20-90.
Sternal transplant using cadaveric allograft (STCA) is a complex and rarely performed surgical procedure usually applied for massive bone tissue loss, sternotomy complications, or neoplastic resections. Although radiological imaging and especially computed tomography (CT) is routinely applied for the post-surgical assessment, up to now, a standardized approach evaluating the outcome of STCAs is missing. Therefore, aim of this study was to qualitatively and quantitatively evaluate, by CT, bone healing after STCA.
The first and the last available postsurgical CT of patients who underwent STCA in two tertiary centers between 2009 and 2017 were collected. Standardized regions of interest were applied on the cancellous bone along the transplanted sternum, and, as reference, on the fourth thoracic vertebra, at both time points, collecting the density values. The areas nearby the fixation devices were assessed by a four-points qualitative score. To evaluate the mineralization, the analysis of the variance (ANOVA) with Bonferroni correction was applied for the quantitative measurements while the Wilcoxon test was used for the qualitative score (P<0.05). To evaluate the intra-rater reliability of the qualitative and the quantitative analyses, the same rater repeated the measurements after two months and the Cohen's kappa (k) and the intraclass correlation coefficient (ICC) were computed.
Fourteen patients (11 females, 61±12.8 years) were examined. The first control CTs were performed 32±40.26 days after the STCA and the last CT were acquired after 729±745 days. The quantitative and the qualitative score significantly increased between the two intervals (P<0.05, each). The density of the transplanted sternum was lower than that of the vertebral reference at the first CT (P=0.006) while no differences occurred at the last control (P=0.361). The assessments showed high intra-rater reliability and agreement (ICC ≥0.890, k≥0.906).
The hereby-proposed qualitative and quantitative methods demonstrated to be good tools for assessing bone healing after STCA.
使用尸体同种异体移植物进行胸骨移植（STCA）是一种复杂且很少进行的外科手术，通常用于大量骨组织丢失、胸骨切开术并发症或肿瘤切除。尽管放射影像学，尤其是计算机断层扫描（CT）常规用于术后评估，但到目前为止，缺少评估STCA结果的标准化方法。因此，本研究的目的是通过CT对STCA术后的骨愈合进行定性和定量评估。
收集2009年至2017年期间在两个三级中心接受STCA的患者的首次和最后一次术后可用CT。在两个时间点，在移植胸骨周围的松质骨上以及作为对照的第四胸椎上应用标准化感兴趣区域，收集密度值。通过四点定性评分评估固定装置附近的区域。为了评估矿化情况，对定量测量应用了带有Bonferroni校正的方差分析（ANOVA），而对定性评分使用了Wilcoxon检验（P<0.05）。为了评估定性和定量分析的评分者内信度，同一位评分者在两个月后重复测量，并计算了Cohen's kappa（k）和组内相关系数（ICC）。
检查了14名患者（11名女性，61±12.8岁）。首次对照CT在STCA后32±40.26天进行，最后一次CT在729±745天后采集。两个时间间隔之间的定量和定性评分均显著增加（各P<0.05）。在首次CT时，移植胸骨的密度低于椎体对照（P=0.006），而在最后一次对照时无差异（P=0.361）。评估显示评分者内信度和一致性较高（ICC≥0.890，k≥0.906）。
本文提出的定性和定量方法被证明是评估STCA术后骨愈合的良好工具。
