Efficiency of non-operative management for pectus deformities in children using an X-ray-free protocol

OBJECTIVES

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 carinatum (PC). To assess the variation of 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

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 mm ± 7.2 vs 13.8 mm ± 6.1, respectively; p < 0.05 and for PC 31.1 mm ± 10.6 vs 16.7 mm ± 8.9, 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.

Transperineal ultrasound to assess anal positioning in female neonates

AIMS

Anterior anal displacement is a condition that is difficult to define: is it merely an anatomical variation within the range of normality or is it a genuine malformation? In order to improve early diagnosis of anterior displacement of the anus, this study assessed the feasibility of transperineal ultrasound (US) in routine practice for use as first-line management.

MATERIALS AND METHODS

Sagittal perineal US was performed on 187 female infants aged between 3 and 9 weeks. The ultrasound was performed randomly, either by a senior or a junior radiologist. The imaging by the senior radiologists defined the sagittal plane quality criteria. Scores to define image quality were established and then validated. The percentage of satisfactory images was then compared according to the planes and the seniority (junior vs. senior) of the radiologists. The junior radiologists were evaluated from the beginning to determine the learning curve for optimal image acquisition.

RESULTS

The quality scores for the perineal ultrasounds revealed excellent intra-and inter-operator performances: 84.4% of the sagittal plane images were satisfactory. After the 20th examination, the success rate for the sagittal plane was independent of the seniority of the radiologist.

CONCLUSIONS

This preliminary study demonstrates that transperineal sagittal plane US is easy to learn and readily yields reproducible results. The possibility of using this technique provides a solid basis for further studies to evaluate its relevance in regard to clinical data and MRI results, with the aim of providing a reliable early diagnostic tool for routine practice.