title: Usefulness of chest images for the assessment of pectus excavatum before and after a Nuss repair in adults.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether chest radiographs could offer useful information for the assessment of pectus excavatum (PE) before and after Nuss repair in adults.
  
  
  METHODS
  A total of 154 adults, with a mean age of 24.0 ± 5.0 years (range, 18-44 years), who underwent a Nuss repair of PE, with a mean follow-up of 42 months (range, 14-71 months), were included in this retrospective study. Sixty-two of these patients were also evaluated after the pectus bar removal, with a mean follow-up of 13 months (range, 6-44 months). The preoperative and postoperative imaging modalities were compared.
  
  
  RESULTS
  The preoperative mean Haller indices measured on computed tomography (CT) and chest radiographs were 4.61 ± 1.58 (range, 2.6-11.9) and 3.82 ± 1.17 (range, 2.0-10.2), respectively. The Pearson correlation coefficient between the two parameters was 0.757. The postoperative mean Haller index measured on chest radiographs was 2.86 ± 0.56 (range, 1.7-5.4) and showed statistically significant improvement compared with the preoperative index (P < 0.001). The mean sternovertebral (SV) distances detected on preoperative and postoperative (>6 months after surgery) lateral chest radiographs were 7.67 ± 1.89 cm (range, 2.5-12.9 cm) and 9.89 ± 1.80 cm (range, 4.6-15.0 cm), respectively, showing statistically significant improvement (P < 0.001). The mean sternovertebral (SV) distance in patients after the bar removal detected on lateral chest radiographs was 9.25 ± 2.14 cm, also showing statistically significant improvement compared with the preoperative value (P < 0.001).
  
  
  CONCLUSIONS
  Haller indices measured using chest radiographs and CT showed a strong correlation. Therefore, chest radiographs can be used as an alternative tool for the preoperative evaluation of PE. The Nuss operation significantly improved SV distances detected on lateral chest radiographs. Lateral chest radiographs can be used as a simple modality for the objective quantitative assessment of the anatomic results and follow-up of the Nuss operation in adults.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery,  Tri-Service General Hospital, National Defense Medical Center, Taipei,  Taiwan.
authors.forename: Ti-Hei
authors.initials: TH
authors.lastname: Wu
authors.forename: Tsai-Wang
authors.initials: TW
authors.lastname: Huang
authors.forename: Hsian-Her
authors.initials: HH
authors.lastname: Hsu
authors.forename: Shih-Chun
authors.initials: SC
authors.lastname: Lee
authors.forename: Ching
authors.initials: C
authors.lastname: Tzao
authors.forename: Huang
authors.initials: H
authors.lastname: Chang
authors.forename: Yeung-Leung
authors.initials: YL
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult