Quantitative evaluation of bone and cartilage changes after the Ravitch thoracoplasty by multislice computed...

Various bone and cartilage changes after the Ravitch thoracoplasty have recently been reported. In this study, quantitative measurements of long-term changes in the bone, cartilage, and contour of the chest wall through the use of multislice computed tomography with 3-dimensional reconstruction are presented.

Between 1985 and 2002, 114 patients with pectus excavatum received the Ravitch thoracoplasty in our hospital. Multislice computed tomography with 3-dimensional reconstruction was undertaken in 36 patients 4 to 18 years after the initial operation. Twenty-four patients with pectus excavatum without a surgical intervention were enrolled as a control group. The voxel size of calcification/ossification in regenerated cartilage, costal cartilage shortening ratio, and clubbing index were calculated to quantify the long-term bone and cartilage changes.

The calcification/ossification volume was measured as 5.29 +/- 6.94 cm3, which was significantly correlated with the patient's age at the time of the operation (P = .001). The costal cartilage shortening ratio showed significant shortening of the regenerated cartilage in the third to sixth ribs bilaterally (P < 0.05), and the clubbing index confirmed significant clubbing in the bony ends of the third to fifth ribs (P < 0.05). These changes were not demonstrated in the control group.

After undergoing the Ravitch thoracoplasty, patients sustained significant bone and cartilage changes. The use of multislice computed tomography with 3-dimensional reconstruction may offer both images and quantitative measurements of these changes, but further investigation is necessary to elucidate the clinical impact of these phenomena.