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Published on: June 11, 2019
Advantages of Cardiac Magnetic Resonance Imaging for Severe Pectus Excavatum Assessment in Children
Mariela Dore1, Paloma Triana Junco1, Monserrat Bret2
1Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Insights
Cardiac magnetic resonance imaging (c-MRI) offers a radiation-free method for assessing pectus excavatum (PE) and its impact on heart function. This technique provides detailed insights for surgical planning.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Pectus excavatum (PE) can cause cardiac dysfunction due to chest compression.
- Cardiac magnetic resonance imaging (c-MRI) is increasingly used for PE assessment due to radiation dose reduction.
- Previous protocols relied on computed tomography (CT) for PE evaluation.
Purpose of the Study:
- To evaluate the findings of c-MRI in pectus excavatum patients 18 months after protocol change.
- To compare c-MRI assessment with previous CT-based protocols.
- To analyze the impact of PE on cardiac function using c-MRI.
Main Methods:
- Retrospective analysis of 20 severe PE patients assessed with inspiratory and expiratory c-MRI.
- Evaluation of radiologic PE indexes (Haller's, correction, asymmetry, sternal rotation).
- Assessment of cardiac function, including left and right ventricle ejection fraction.
Main Results:
- Dynamic c-MRI revealed significant differences in Haller's and correction indexes between inspiration and expiration.
- Right ventricle ejection fraction was found to be 50.3%, below the normal range.
- c-MRI provided a comprehensive, radiation-free assessment of chest wall deformity and cardiac function, outperforming echocardiography.
Conclusions:
- c-MRI enables radiation-free imaging of PE deformities throughout the breathing cycle.
- It effectively evaluates sternum impingement on cardiac function.
- Findings facilitate precise surgical evaluation and preoperative planning for PE patients.
Aim:
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.
Patients And Methods:
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).
Results:
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) (p < 0.05), and correction index (26.86% vs. 36.84%, respectively, p < 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.
Conclusion:
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.
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