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. 2020 Apr;12(4):1475-1487.
doi: 10.21037/jtd.2020.02.31.

Optical imaging versus CT and plain radiography to quantify pectus severity: a systematic review and meta-analysis

Jean H T Daemen  1 , Tom G J Loonen  2 , Pieter W J Lozekoot  1 , Jos G Maessen  3   4 , Thomas J J Maal  2 , Karel W E Hulsewé  1 , Yvonne L J Vissers  1 , Erik R de Loos  1
Affiliations

Optical imaging versus CT and plain radiography to quantify pectus severity: a systematic review and meta-analysis

Jean H T Daemen et al. J Thorac Dis. 2020 Apr.

Abstract

Background: Computed tomography (CT) and two-view chest radiographies are the most commonly used imaging techniques to quantify the severity of pectus excavatum (PE) and pectus carinatum (PC). Both modalities expose patients to ionizing radiation that should ideally be avoided, especially in pediatric patients. In an effort to diminish this exposure, three-dimensional (3D) optical surface imaging has recently been proposed as an alternative method. To assess its clinical value as a tool to determine pectus severity we conducted a systematic review in which we assessed all studies that compared 3D scan-based pectus severity measurements with those derived from CT-scans and radiographies.

Methods: Six scientific databases and three registries were searched through April 30th, 2019. Data regarding the correlation between severity measures was extracted and submitted to meta-analysis using the random-effects model and I2-test for heterogeneity.

Results: Five observational studies were included, enrolling 75 participants in total. Pooled analysis of participants with PE demonstrated a high positive correlation coefficient of 0.89 [95% confidence interval (CI): 0.81 to 0.93; P<0.001] between the CT-derived Haller index (HI) and its 3D scan equivalent based on external measures. No heterogeneity was detected (I2=0.00%; P=0.834).

Conclusions: 3D optical surface scanning is an attractive and promising imaging technique to determine the severity of PE without exposure to ionizing radiation. However, further research is needed to determine novel cut-off values for 3D scans to facilitate clinical decision making and help determine surgical candidacy. No evidence was found that supports nor discards the use of 3D scans to determine PC severity.

Keywords: Three-dimensional optical surface imaging (3D optical surface imaging); external Haller index (EHI); pectus carinatum (PC); pectus excavatum (PE).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.02.31). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Risk of bias per individual study. NR, not reported.
Figure 2
Figure 2
A PRISMA flow diagram of the study selection procedure. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; WoS, Web of Science; CINAHL, Cumulative Index to Nursing and Allied Health Literature; WHO-ICTRP, World Health Organization International Clinical Trials Registry Platform.
Figure 3
Figure 3
Pectus severity measurement methods.. (A) Severity indices based on 3D surface scans; (B) severity indices based on CT-scans. EHI, external Haller index; MEHI, modified external Haller index; ECI, external correction index; HI, Haller index; MHI, modified Haller index; CI, correction index; 3D, three-dimensional.
Figure 4
Figure 4
Meta-analysis demonstrating the correlation of 3D optical surface scan based EHI and CT-scan based HI among participants with pectus excavatum, using Fisher’s Z-score as effect size. CI, confidence interval; 3D, three-dimensional; CT, computed tomography; EHI, external Haller index; HI, Haller index.
Figure 5
Figure 5
A standard error by Fisher’s Z transformed correlation coefficient to detect the presence of publication bias among the studies that were included for quantitative synthesis.
Figures S1
Figures S1
PubMed.
Figures S2
Figures S2
EMBASE.
Figures S3
Figures S3
Web of Science.
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Figures S4
Cochrane Library.
Figures S5
Figures S5
CINAHL.
See this image and copyright information in PMC

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