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Breath-hold MRI in evaluating patients with pectus excavatum

¹Department of Child Health, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester LE2 7LX, and Departments of ²Radiology and ³Cardiothoracic Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK

View larger version (103K): [in a new window]   Figure 1. Chest wall measurements. Fast TurboFLASH axial image with measurements of the skeletal extent of pectus excavatum deformity. Pectus Index=b/a; chest flatness=b/c; mean anteroposterior chest wall movement=100[(ci/ce)+(c'i/c'e)-2]/2, where the subscripts i and e are the full inspiratory and expiratory measurements, respectively. a, minimum sternovertebral distance (minimum anteroposterior diameter) at the level of greatest deformity; b, maximum internal transverse diameter of the thorax; c and c', maximum anteroposterior rib diameters on the right and left sides, respectively, at the level of greatest deformity.

View larger version (62K): [in a new window]   Figure 2. Cardiac displacement. Axial images of (a) full inspiration and (b) full expiration. HL, most lateral distance of the left cardiac border from midline; HR, most lateral distance of the right cardiac border from midline; ......., midline; i, full inspiratory measurement; e, full expiratory measurement.

View larger version (96K): [in a new window]   Figure 3. Diaphragmatic excursion. Coronal images of (a) full inspiration and (b) full expiration. r, fixed line of reference; m, midline. Distances X1=X2 and Y1=Y2. Absolute excursions of the left and right hemidiaphragms (DL and DR) calculated as follows: DL=DLi-DLe and DR=DRi-DRe. i, full inspiratory measurements; e, full expiratory measurements.

View larger version (23K): [in a new window]   Figure 4. Differences in most lateral distance of the left cardiac border from the midline (HL) (control minus patient) in full inspiration () and full expiration () for each subject pair. In pairs 1, 4 and 5 (columns below the zero line), the left heart border of the patient is more laterally located than the control and becomes more marked on full expiration.

View larger version (12K): [in a new window]   Figure 5. Left and right hemidiaphragmatic excursion (D) in patients and controls. Note the relatively greater movement of the left hemidiaphragm dome in the patient group compared with controls. In contrast, a comparatively reduced excursion of the right hemidiaphragm dome in the patients was seen.