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Limited, Fast Magnetic Resonance Imaging as an Alternative for Preoperative Evaluation of Pectus Excavatum: A Feasibility Study

Birkemeier, Krista L. MD*; Podberesky, Daniel J. MD*; Salisbury, Shelia PhD; Serai, Suraj PhD*

doi: 10.1097/RTI.0b013e31822da1b6
Original Articles

Objective: The purpose of this study was to determine the reliability, feasibility, and image quality of a limited, fast magnetic resonance imaging (MRI) protocol for preoperative evaluation of pectus excavatum in a pediatric population referred for presurgical imaging.

Materials and Methods: A total of 47 patients, median age 14 years, referred for preoperative imaging of pectus excavatum, underwent axial balanced steady-state free precession MRI of the chest, with a limited patient charge. Two pediatric radiologists independently conducted a blinded retrospective study. The Haller and asymmetry indices were calculated at the level of greatest anterior-posterior chest narrowing. In addition, right heart compression and image quality were subjectively assessed, and scan duration was determined.

Results: Intraclass correlation coefficient reliability was between 0.85 and 0.98, indicating almost perfect agreement for quantitative measurements. Subjective evaluation of right heart compression and image quality showed moderate interreader agreement. Image quality was graded as good or excellent by both readers for all studies. No difference in the Haller index was observed between modalities in 3 patients on both computed tomographic scan and MRI (P=0.2697). The median scan duration was 8 minutes.

Conclusions: Limited MRI is a reliable and cost-effective alternative for preoperative assessment of pectus excavatum. It is fast, free of ionizing radiation, and there is excellent interreader reliability for measurements of chest wall deformity.


Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Conflicts of interest and source of funding: There were no grants or other financial assistance for this research.

Reprints: Krista L. Birkemeier, MD, Radiology, MLC 5031, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.