Efficiency of non-operative management for pectus deformities in children using an X-ray-free protocol
Alexis Belgacem1, Jérémy Tricard2, Alexandre Dutoit3
1Department of Pediatric Surgery, Limoges University Hospital, Limoges, France.
Insights
This study found that external measurements are reliable for monitoring pectus excavatum (PE) and pectus carinatum (PC) treatment. While external Haller index (EHI) correlates well with MRI-based Haller index (HI) for PE, it
Area of Science:
- Pediatric Surgery
- Medical Imaging
- Orthopedics
Background:
- Pectus deformities, including pectus excavatum (PE) and pectus carinatum (PC), are common chest wall abnormalities in children.
- Non-operative treatments like vacuum bell therapy for PE and compression therapy for PC are widely used.
- Accurate monitoring of treatment effectiveness is crucial for optimizing outcomes.
Purpose of the Study:
- To investigate the correlation between the Haller index (HI) measured by MRI, the external Haller index (EHI) from 3D scanning, and external protrusion measurements.
- To evaluate the changes in HI during the first year of non-operative treatment for PE and PC in pediatric patients.
- To assess the reliability of external measurements as a monitoring tool for these conditions.
Main Methods:
- A cohort of 79 pediatric patients (80 PE, 38 PC) treated between 2018-2022 were analyzed.
- Measurements included MRI for HI, 3D scanning for EHI, and external gauge measurements at baseline (M0) and 12 months (M12).
- Statistical analysis, including Pearson correlation, was used to compare different measurement methods and assess treatment changes.
Main Results:
- Significant reductions in external chest wall depth were observed for both PE and PC within the first year of treatment (P < 0.05).
- A strong positive correlation was found between MRI-derived HI and 3D scanning-derived EHI for both PE (r=0.910) and PC (r=0.934).
- External measurements correlated with EHI in PE (r=0.663) but not in PC, indicating potential limitations for PC monitoring.
Conclusions:
- Non-operative treatment yields excellent results for PE and PC, observable as early as six months.
- External protrusion measurements serve as a reliable tool for clinical monitoring of pectus deformities.
- Caution is advised when using external measurements alone for monitoring PC, as they may not correlate with internal HI changes.
Objectives:
The aim of this study was to explore the correlation between the Haller index (HI), the external depth of protrusion and the external Haller index (EHI) for both pectus excavatum (PE) and pectus carinatum (PC) and to assess the variation in the HI during this first year of non-operative treatment for pectus deformities in children.
Methods:
From January 2018 to December 2022, all children treated for PE by vacuum bell and for PC by compression therapy at our institution were evaluated by external gauge, 3D scanning (iPad with Structure Sensor and Captevia-Rodin4D) and magnetic resonance imaging (MRI). The main objectives were to assess the effectiveness of the treatment during the first year and to compare the HI determined by MRI to the EHI evaluated with 3D scanning and external measurements. The HI determined by MRI was compared to the EHI evaluated with 3D scanning and external measurements at M0 and M12.
Results:
A total of 118 patients (80 PE and 38 PC) had been referred for pectus deformity. Of these, 79 met the inclusion criteria (median age 13.7 years, 8.6-17.8). There was a statistically significant difference in the external measurements of the depth for PE between M0 and M12: 23.0 ± 7.2 vs 13.8 ± 6.1 mm, respectively, P < 0.05, and for PC 31.1 ± 10.6 vs 16.7 ± 8.9 mm, respectively, P < 0.01. During this first year of treatment, the reduction in the external measurement increased more rapidly for PE compared with PC. We found a strong correlation between the HI by MRI and the EHI by 3D scanning for PE (Pearson coefficient = 0.910, P < 0.001) and for PC (Pearson coefficient = 0.934, P < 0.001). A correlation between the EHI by 3D scanning and the external measurements by profile gauge was found for PE (Pearson coefficient = 0.663, P < 0.001) but not for PC.
Conclusions:
Excellent results were observed as soon as the sixth month for both PE and PC. Measurement of protrusion is a reliable monitoring tool at clinical consultation but caution is required for PC as it does not appear to be correlated to the HI by MRI.
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