Quantitative evaluation of bone and cartilage changes after the Ravitch thoracoplasty by multislice computed tomography with 3-dimensional reconstruction.
OBJECTIVE
Various bone and cartilage changes after the Ravitch thoracoplasty have recently been reported. In this study, quantitative measurements of long-term changes in the bone, cartilage, and contour of the chest wall through the use of multislice computed tomography with 3-dimensional reconstruction are presented.


METHODS
Between 1985 and 2002, 114 patients with pectus excavatum received the Ravitch thoracoplasty in our hospital. Multislice computed tomography with 3-dimensional reconstruction was undertaken in 36 patients 4 to 18 years after the initial operation. Twenty-four patients with pectus excavatum without a surgical intervention were enrolled as a control group. The voxel size of calcification/ossification in regenerated cartilage, costal cartilage shortening ratio, and clubbing index were calculated to quantify the long-term bone and cartilage changes.


RESULTS
The calcification/ossification volume was measured as 5.29 +/- 6.94 cm3, which was significantly correlated with the patient's age at the time of the operation (P = .001). The costal cartilage shortening ratio showed significant shortening of the regenerated cartilage in the third to sixth ribs bilaterally (P < 0.05), and the clubbing index confirmed significant clubbing in the bony ends of the third to fifth ribs (P < 0.05). These changes were not demonstrated in the control group.


CONCLUSIONS
After undergoing the Ravitch thoracoplasty, patients sustained significant bone and cartilage changes. The use of multislice computed tomography with 3-dimensional reconstruction may offer both images and quantitative measurements of these changes, but further investigation is necessary to elucidate the clinical impact of these phenomena.
Chang
Pei-Yeh
PY
Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Lai
Jin-Yao
JY
Chen
Jeng-Chang
JC
Wang
Chao-Jan
CJ
D000293:Adolescent; D000328:Adult; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002356:Cartilage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D035441:Thoracic Wall / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013905:Thoracoplasty; D014057:Tomography, X-Ray Computed