Patrick M Poston1, Michael A McHugh1, Nicholas O Rossi1, Sonali S Patel2, Maheen Rajput3, Joseph W Turek4. 1. Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, SE 520 GH, Iowa City, IA 52242-1062, USA. 2. Pediatric Cardiology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA. 3. Radiology, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, 3773 JPP, Iowa City, IA 52242-1062, USA. 4. Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, SE 520 GH, Iowa City, IA 52242-1062, USA. Electronic address: joseph-turek@uiowa.edu.
Abstract
BACKGROUND: We previously reported the use of a computed tomography (CT)-based Correction Index (CI) as a more accurate assessment of pectus excavatum (PE) severity than the historically used Haller Index (HI). This study examines the diagnostic capabilities of the CI as assessed by lateral chest radiography (CXR). METHODS: A database of PE patients receiving preoperative CXR and CT was created. For each patient, a radiologist calculated a CT-based CI, while two pediatric surgeons independently calculated CXR CIs. RESULTS: The database was composed of 69 patients. Significant correlations were found between CXR CI estimates of the two observers and between the CXR and CT CI for each observer. Per our previous work, CT CIs were used in this study for identifying patients meeting surgical criteria (CT CI≥28%). Observed CXR CIs demonstrated good interrater reliability. The sensitivity (0.83) and specificity (0.77) of CXR in diagnosing severe PE (CT CI≥28%) was high. However, sensitivity (0.89) markedly improved when only considering measured CXR CIs≤26%, and combined specificity rose to 0.86 when only considering measured CXR CIs≥30%. CONCLUSIONS: We recommend the CI as measured by lateral CXR for the preoperative evaluation of PE, with CT used as a confirmatory test in patients measured to have a CXR CI between 26% and 30%.
BACKGROUND: We previously reported the use of a computed tomography (CT)-based Correction Index (CI) as a more accurate assessment of pectus excavatum (PE) severity than the historically used Haller Index (HI). This study examines the diagnostic capabilities of the CI as assessed by lateral chest radiography (CXR). METHODS: A database of PE patients receiving preoperative CXR and CT was created. For each patient, a radiologist calculated a CT-based CI, while two pediatric surgeons independently calculated CXR CIs. RESULTS: The database was composed of 69 patients. Significant correlations were found between CXR CI estimates of the two observers and between the CXR and CT CI for each observer. Per our previous work, CT CIs were used in this study for identifying patients meeting surgical criteria (CT CI≥28%). Observed CXR CIs demonstrated good interrater reliability. The sensitivity (0.83) and specificity (0.77) of CXR in diagnosing severe PE (CT CI≥28%) was high. However, sensitivity (0.89) markedly improved when only considering measured CXR CIs≤26%, and combined specificity rose to 0.86 when only considering measured CXR CIs≥30%. CONCLUSIONS: We recommend the CI as measured by lateral CXR for the preoperative evaluation of PE, with CT used as a confirmatory test in patients measured to have a CXR CI between 26% and 30%.
Authors: Andrea Sonaglioni; Massimo Baravelli; Antonio Vincenti; Roberta Trevisan; Maurizio Zompatori; Gian Luigi Nicolosi; Michele Lombardo; Claudio Anzà Journal: Int J Cardiovasc Imaging Date: 2018-05-15 Impact factor: 2.357