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[Benefits of magnetic resonance for the study of pectus excavatum in children: initial experience]
M Dore Reyes1, C De La Torre1, M Bret Zurita2
1Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
Insights
Magnetic resonance imaging (MRI) is a feasible tool for evaluating pectus excavatum (PE), offering a comprehensive assessment of anatomical and cardiovascular changes. This radiation-free technique provides dynamic imaging superior to echocardiography for surgical planning.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Diagnostic Radiology
Background:
- Pectus excavatum (PE) causes cardiovascular alterations due to mediastinum compression.
- Accurate anatomical and functional assessment is crucial for effective PE treatment.
- Current imaging techniques may not fully capture the extent of PE's impact.
Purpose of the Study:
- To evaluate the utility of magnetic resonance imaging (MRI) in assessing pectus excavatum (PE).
- To compare MRI's diagnostic capabilities with existing imaging modalities for PE.
- To explore MRI's role in pre-surgical evaluation for PE.
Main Methods:
- Retrospective analysis of 10 patients with PE undergoing MRI.
- Evaluation of PE indices: Haller, correction, asymmetry, and sternal rotation.
- Comparative analysis of right ventricular function using MRI and echocardiography.
Main Results:
- MRI revealed specific Haller index, correction index, and sternal rotation values.
- Median right ventricular ejection fraction (EFRV) was 50%, with 90% of patients below normal.
- Echocardiography underestimated functional cardiovascular alterations in all patients.
Conclusions:
- MRI is a feasible imaging choice for evaluating PE patients prior to surgical correction.
- The absence of radiation allows for comprehensive, dynamic anatomical and cardiovascular assessment.
- MRI offers a more complete evaluation compared to traditional methods like echocardiography.
Introduction/Aim Of The Study:
In patients with PE, cardiovascular alterations ensue as a result of the mediastinum compression caused by sternum impingement and is responsible of many of the symptoms. Anatomical and functional assessment is of the utmost importance for a comprehensive understanding of the disease and an adequate treatment plan. Our aim was to describe the use of magnetic resonance image (MRI) in the study of PE and whether it is comparable to imaging techniques.
Patients And Methods:
A retrospective study of the first 10 patients in which an MRI was performed as part of PE assessment within august 2015-2016. PE indexes were evaluated: Haller, correction, asymmetry, as well as sternal rotation. An analysis of right ventricular function was carried out comparing echocardiogram and MRI.
Results:
MRI scan on 10 patients showed the following findings: Haller index: inspiration: 3.75 (3.5-7.3) and expiration 4,9 (3.9-10.8), correction index of 24% (5-37%) and a sternal rotation of 12º (0-31º). The cardiovascular study showed a median ejection fraction of the right ventricle (EFRV) of 50% (38-64%), with 9 of the 10 patients under the normal value of 61% (54-71%). Echocardiographic findings underestimated functional alterations in all of the patients.
Conclusion:
This initial study suggests that the use of MRI as a test of choice in the evaluation of PE subject to surgical correction is feasible. Absence of radiation offers the capacity of a complete and dynamic anatomical as well as cardiovascular study.
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