Dynamic magnetic resonance imaging in unilateral diaphragm eventration: knowledge improvement before and after plication.
Diaphragm eventration
diaphragm plication
dynamic magnetic resonance imaging (dMRI)
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
entrez:
28
9
2019
pubmed:
29
9
2019
medline:
29
9
2019
Statut:
ppublish
Résumé
The assessment before surgical plication for unilateral hemidiaphragm (HD) eventration is not clearly defined and no precise criteria exist to really understand which patient is operated with which results depending on the technique used. The goal of this study was to evaluate the place of dynamic magnetic resonance imaging (dMRI) before and after plication by developing measurement criteria. Between 2006 and 2017, 18 patients (group1: Gp1) were operated for eventrations, 15 left-sided (Gp1L) and 3 right-sided (Gp1R). All had preoperative and postoperative evaluations including dMRI and pulmonary function tests. Five healthy volunteer subjects (group2: Gp2) had the same imaging protocol. For each HD, we measured the respiratory excursion at three fixed points (S1, S2, S3) and the height of curvature on sagittal plane. We also searched for upward paradoxical diaphragm movements. Before surgery, no excursion (n=13) or extremely reduced excursion (n=5) was detected on the injured HD (IHD) in Gp1. Upward paradoxical movements were identified only in Gp1L (n=6). Compared with Gp2 subjects, the healthy HD for Gp1L patients had significantly reduced excursion values at three sites S1 (P=0.038), S2 (P=0.006), and S3 (P=0.004). After plication, the decreasing height of curvature confirmed a tightening of the IHD in all patients (median value from 100 to 39.5 mm in Gp1L and 92 to 74 mm in Gp1R, P=0.0001). All upward paradoxical movements disappeared. Healthy HD excursions in Gp1L normalised their values. All those imaging improvements were correlated with postoperative improvements of dyspnoea score (P<0.0001) and vital capacity (P=0.002). dMRI and the standardised grid we developed not only improve the knowledge of unilateral diaphragm eventration but also permit to evaluate the quality of its surgical repair. It also demonstrates that a dysfunction of the healthy HD contralateral to eventration is possible and reversible after plication of the IHD.
Sections du résumé
BACKGROUND
BACKGROUND
The assessment before surgical plication for unilateral hemidiaphragm (HD) eventration is not clearly defined and no precise criteria exist to really understand which patient is operated with which results depending on the technique used. The goal of this study was to evaluate the place of dynamic magnetic resonance imaging (dMRI) before and after plication by developing measurement criteria.
METHODS
METHODS
Between 2006 and 2017, 18 patients (group1: Gp1) were operated for eventrations, 15 left-sided (Gp1L) and 3 right-sided (Gp1R). All had preoperative and postoperative evaluations including dMRI and pulmonary function tests. Five healthy volunteer subjects (group2: Gp2) had the same imaging protocol. For each HD, we measured the respiratory excursion at three fixed points (S1, S2, S3) and the height of curvature on sagittal plane. We also searched for upward paradoxical diaphragm movements.
RESULTS
RESULTS
Before surgery, no excursion (n=13) or extremely reduced excursion (n=5) was detected on the injured HD (IHD) in Gp1. Upward paradoxical movements were identified only in Gp1L (n=6). Compared with Gp2 subjects, the healthy HD for Gp1L patients had significantly reduced excursion values at three sites S1 (P=0.038), S2 (P=0.006), and S3 (P=0.004). After plication, the decreasing height of curvature confirmed a tightening of the IHD in all patients (median value from 100 to 39.5 mm in Gp1L and 92 to 74 mm in Gp1R, P=0.0001). All upward paradoxical movements disappeared. Healthy HD excursions in Gp1L normalised their values. All those imaging improvements were correlated with postoperative improvements of dyspnoea score (P<0.0001) and vital capacity (P=0.002).
CONCLUSIONS
CONCLUSIONS
dMRI and the standardised grid we developed not only improve the knowledge of unilateral diaphragm eventration but also permit to evaluate the quality of its surgical repair. It also demonstrates that a dysfunction of the healthy HD contralateral to eventration is possible and reversible after plication of the IHD.
Identifiants
pubmed: 31559052
doi: 10.21037/jtd.2019.07.79
pii: jtd-11-08-3467
pmc: PMC6753452
doi:
Types de publication
Journal Article
Langues
eng
Pagination
3467-3475Déclaration de conflit d'intérêts
Conflicts of Interest: The authors have no conflicts of interest to declare.
Références
Radiology. 2000 May;215(2):574-83
pubmed: 10796942
Eur J Cardiothorac Surg. 2002 Feb;21(2):294-7
pubmed: 11825738
J Magn Reson Imaging. 2004 May;19(5):605-9
pubmed: 15112310
J Appl Physiol (1985). 1992 Apr;72(4):1407-12
pubmed: 1592732
Radiology. 2006 Aug;240(2):537-45
pubmed: 16801367
Eur J Anaesthesiol Suppl. 2008;42:186-91
pubmed: 18289440
Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):276-84
pubmed: 19540059
Crit Care Med. 2011 Dec;39(12):2627-30
pubmed: 21705883
Ann Thorac Surg. 1990 Feb;49(2):248-51; discussion 252
pubmed: 2306146
Muscle Nerve. 2013 Mar;47(3):319-29
pubmed: 23382111
Curr Opin Pulm Med. 2013 Jul;19(4):394-8
pubmed: 23715292
J Appl Physiol (1985). 1989 Oct;67(4):1311-8
pubmed: 2676953
Respiration. 2016;91(5):403-11
pubmed: 27216909
J Appl Physiol (1985). 1989 Aug;67(2):694-8
pubmed: 2793672
J Thorac Cardiovasc Surg. 2017 May;153(5):1182-1188
pubmed: 28087113
BMC Pulm Med. 2018 Aug 2;18(1):126
pubmed: 30068327
Clin Radiol. 1966 Jan;17(1):79-83
pubmed: 4221861
Clin Radiol. 1969 Apr;20(2):231-3
pubmed: 5771635