Objective: To evaluate the application of cameral-type three-dimensional (3D) scan in the assessment of funnel chest.
Methods: Eighty children with funnel chest were collected from the Children's Hospital, Zhejiang University School of Medicine during June 2016 and December 2017. All patients underwent routine CT scan. In the same selected mediastinal window, the lowest point of the depression to the front of the spine was the anteroposterior diameter (A1), and the maximum left to right diameter was B1 (which was perpendicular to A1). The ratio B1/A1 was calculated to get CT Haller index (CT-HI). In the same period, the chest wall scan was performed by EinScan-Pro 3D scanner, and the image was analyzed by GeoMedic image software. On the plane of the most concave point of the sternum, the distance from the lowest point of the skin to the back skin was the anteroposterior diameter (A2), the maximum plane diameter was measured on the same plane (B2), and the ratio B2/A2 was the 3D-Haller index (3D-HI). Pearson correlation analysis was used to analyze the consistency of the two measurements. Kappa test was used to analyze the consistency of surgical indication based on cutoff value of CT-HI and 3D-HI.
Results: All children were able to cooperate with CT and 3D chest wall surface scan. The mean value of CT-HI was 3.82±0.96, and that of 3D-HI was 1.82±0.23. Pearson correlation analysis showed that the correlation coefficient between CT-HI and 3D-HI was 0.823 (P<0.01). When CT-HI > 3.2 and 3D-HI > 1.7 were set as cutoff values for indication of operation, the sensitivity and specificity of 3D-HI were 90.48% and 100.0%, respectively. 3D-HI was well consistent with CT-HI in surgical indication (Kappa=0.801).
Conclusions: s 3D scan can be used to assess the funnel chest in children, and 3D-HI>1.7 can be used as the cutoff value for surgical indication.
目的: 探讨照相式三维扫描在漏斗胸评估中的应用。
方法: 选择2016年6月至2017年12月在浙江大学医学院附属儿童医院门诊就诊的80例漏斗胸患儿。所有患儿均常规行胸部CT平扫，选取同一层面纵隔窗，凹陷最低点到脊柱前方为前后径（A 1），同时测量与之垂直的最大左右径（B 1），计算两者的比值（B 1/A 1）得到CT Haller指数（CT-HI）。同期采用EinScan-Pro多功能手持式三维扫描仪行胸壁扫描，应用GeoMedic图像软件进行测量分析。在胸骨最凹点的平面上，凹陷最低点皮肤到背部皮肤的距离为前后径（A 2），同一平面测量最大左右径（B 2），计算两者的比值（B 2/A 2）得到3D-Haller指数（3D-HI）。采用Pearson相关分析对两种测量方法所得结果进行一致性分析，Kappa检验进行CT-HI和3D-HI判定手术指征的一致性分析。
结果: 所有患儿均能安静配合CT及三维扫描检查。80例患儿的CT-HI平均值为3.82±0.96，3D-HI平均值为1.82±0.23。Pearson检验结果显示，CT-HI和3D-HI的相关系数为0.823（ P < 0.01）。以CT-HI大于3.2作为判定患儿具有手术指征的界值，则以3D-HI大于1.7判断患儿是否具有手术指征的敏感度为90.48%，特异度为100.0%。CT-HI和3D-HI判定患儿是否具有手术指征具有较高的一致性（Kappa值=0.801）。
结论: 三维扫描可用于漏斗胸的评估，当3D-HI大于1.7时提示患儿具有手术指征。