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Hassani S, Tong Y, Lomer NB, Udupa JK, Wu C, McDonough JM, Gogel S, Mayer OH, Biko DM, Cahill PJ, Anari JB, Torigian DA. Comparative analysis of thoracic structure and function using CT and dynamic MRI in pediatric thoracic insufficiency syndrome with and without neuromuscular disease. Spine Deform 2025:10.1007/s43390-025-01095-y. [PMID: 40327258 DOI: 10.1007/s43390-025-01095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Accepted: 04/19/2025] [Indexed: 05/07/2025]
Abstract
PURPOSE Thoracic insufficiency syndrome (TIS) impairs normal respiration and lung growth. In pediatric patients with or without neuromuscular disease (NMD), the relationship between thoracic structure and regional respiratory function remains understudied. We aimed to evaluate these interrelationships using dynamic magnetic resonance imaging (dMRI) and computed tomography (CT). METHODS This study included 25 pediatric TIS patients: 8 with NMD and 17 without NMD. Thoracic dMRI and CT images were analyzed to quantify intercostal muscle (ICM) volume, skeletal muscle (SM) volume, lung volumes at end-inspiration and end-expiration, chest wall excursion volume, and diaphragm excursion volume. Right-to-left volumetric symmetry ratios were compared using unpaired t-testing, and correlations between structural and functional parameters were assessed using Pearson correlation analysis. RESULTS Lung and muscle volumes were generally larger in the TIS-NMD compared to TIS non-NMD, reflecting age-related differences, although lung tidal volumes and diaphragmatic and chest wall excursion volumes were generally similar. The degree of asymmetry reflected by diaphragmatic respiratory function symmetry ratios exceeded that of chest wall symmetry ratios in both groups, with greater disparity in TIS-NMD (3.6 vs 1.8 in TIS-NMD compared to 2.8 vs 2.5 in TIS non-NMD). Correlation between thoracic SM volume and tidal volume was stronger than the correlation between ICM volume and tidal volume in both groups. TIS-NMD patients demonstrated unique compensatory dynamics, including a negative correlation between SM volume and diaphragmatic excursion volume. CONCLUSION Distinct interrelationships exist between thoracic structure and function in TIS patients with and without NMD. These findings suggest that NMD significantly influences respiratory mechanics, emphasizing the role of SM and diaphragm interaction.
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Affiliation(s)
- Sara Hassani
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Yubing Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Nima Broomand Lomer
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Jayaram K Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Caiyun Wu
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joseph M McDonough
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Samantha Gogel
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Oscar H Mayer
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - David M Biko
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Patrick J Cahill
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jason B Anari
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Drew A Torigian
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Tong Y, Udupa JK, McDonough JM, Wu C, Xie L, Rajapakse CS, Gogel S, Sarkar S, Mayer OH, Anari JB, Torigian DA, Cahill PJ. Characterizing Lung Parenchymal Aeration via Standardized Signal Intensity from Free-breathing 4D Dynamic MRI in Phantoms, Healthy Children, and Pediatric Patients with Thoracic Insufficiency Syndrome. Radiol Cardiothorac Imaging 2024; 6:e230262. [PMID: 39051878 PMCID: PMC11369656 DOI: 10.1148/ryct.230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 05/02/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024]
Abstract
Purpose To investigate free-breathing thoracic bright-blood four-dimensional (4D) dynamic MRI (dMRI) to characterize aeration of parenchymal lung tissue in healthy children and patients with thoracic insufficiency syndrome (TIS). Materials and Methods All dMR images in patients with TIS were collected from July 2009 to June 2017. Standardized signal intensity (sSI) was investigated, first using a lung aeration phantom to establish feasibility and sensitivity and then in a retrospective research study of 40 healthy children (16 male, 24 female; mean age, 9.6 years ± 2.1 [SD]), 20 patients with TIS before and after surgery (11 male, nine female; mean age, 6.2 years ± 4.2), and another 10 healthy children who underwent repeated dMRI examinations (seven male, three female; mean age, 9 years ± 3.6). Individual lungs in 4D dMR images were segmented, and sSI was assessed for each lung at end expiration (EE), at end inspiration (EI), preoperatively, postoperatively, in comparison to normal lungs, and in repeated scans. Results Air content changes of approximately 6% were detectable in phantoms via sSI. sSI within phantoms significantly correlated with air occupation (Pearson correlation coefficient = -0.96 [P < .001]). For healthy children, right lung sSI was significantly lower than that of left lung sSI (at EE: 41 ± 6 vs 47 ± 6 and at EI: 39 ± 6 vs 43 ± 7, respectively; P < .001), lung sSI at EI was significantly lower than that at EE (P < .001), and left lung sSI at EE linearly decreased with age (r = -0.82). Lung sSI at EE and EI decreased after surgery for patients (although not statistically significantly, with P values of sSI before surgery vs sSI after surgery, left and right lung separately, in the range of 0.13-0.51). sSI varied within 1.6%-4.7% between repeated scans. Conclusion This study demonstrates the feasibility of detecting change in sSI in phantoms via bright-blood dMRI when air occupancy changes. The observed reduction in average lung sSI after surgery in pediatric patients with TIS may indicate postoperative improvement in parenchymal aeration. Keywords: MR Imaging, Thorax, Lung, Pediatrics, Thoracic Surgery, Lung Parenchymal Aeration, Free-breathing Dynamic MRI, MRI Intensity Standardization, Thoracic Insufficiency Syndrome Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Yubing Tong
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Jayaram K. Udupa
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Joseph M. McDonough
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Caiyun Wu
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Lipeng Xie
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Chamith S. Rajapakse
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Samantha Gogel
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Sulagna Sarkar
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Oscar H. Mayer
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Jason B. Anari
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Drew A. Torigian
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Patrick J. Cahill
- From Department of Radiology, the Medical Image Processing Group,
University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl,
Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell
Center for Thoracic Insufficiency Syndrome, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments
of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia,
Pa (C.S.R.); and Division of Pulmonology, The Children’s Hospital of
Philadelphia, Philadelphia, Pa (O.H.M.)
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Zhang Y, Li Q, Shi Z, Li Q, Dai X, Pan C, Ma Y, Yan R, Fei D, Xie J. A novel growth-friendly system alleviates pulmonary dysplasia in early-onset scoliosis combined with thoracic insufficiency syndrome: Radiological, pathological, and transcriptomic assessments. Heliyon 2024; 10:e27887. [PMID: 38509966 PMCID: PMC10951595 DOI: 10.1016/j.heliyon.2024.e27887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
Background The posterior procedure utilizing growth-friendly techniques is the golden standard for patients with early-onset scoliosis combined with thoracic insufficiency syndrome (EOS + TIS). Pulmonary hypoplasia is the main cause of dying prematurely in the EOS + TIS. This study assessed the therapeutic impact of a novel growth-friendly system on the pulmonary development of piglet's EOS + TIS model. Methods The animal procedure period lasts 12 weeks, of which the construction of the EOS + TIS was performed at 0-8 weeks, and implantation of a novel growth-friendly system was applied at 8-12 weeks. During the animal procedure, X-rays and CT were performed to observe scoliosis, thorax, and lungs. After 12 weeks, pathological changes in lung tissue were assessed using HE and IHC staining. RNA-seq characterized novel growth-friendly system-associated differentially expressed genes (DEGs) and validated using RT-qPCR, western blotting, and IHC. Results Implantation of the novel growth-friendly system increased body weight, body length, and total lung volume, as well as decreased the coronal and sagittal Cobb angles for the EOS + TIS model. It also ameliorated EOS + TIS-induced thickening of the alveolar wall, increased alveolar spaces, and decreased alveolar number and diameter. In lung tissue, a total of 790 novel growth-friendly system-associated DEGs were identified, and they were mainly involved in the regulation of immune, inflammatory, calcium transport, and vascular development. Among these DEGs, BDKRB1, THBS1, DUSP1, IDO1, and SPINK5 were hub genes, and their differential expression was consistent with RNA-seq results in lung tissues. Conclusion The novel growth-friendly system has mitigated scoliosis and pulmonary hypoplasia in the EOS + TIS model. We further elucidate the molecular mechanisms underlying the amelioration of pulmonary hypoplasia.
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Affiliation(s)
- Ying Zhang
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Quan Li
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Zhiyue Shi
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Qitang Li
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Xinfei Dai
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Cheng Pan
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Yujian Ma
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Rongshuang Yan
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Derui Fei
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Jingming Xie
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
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Inserra A, Zarfati A, Pardi V, Bertocchini A, Accinni A, Aloi IP, Martucci C, Frediani S. Case report: A simple and reliable approach for progressive internal distraction of the sternum for Jeune syndrome (asphyxiating thoracic dystrophy): preliminary experience and literature review of surgical techniques. Front Pediatr 2023; 11:1253383. [PMID: 37822322 PMCID: PMC10562558 DOI: 10.3389/fped.2023.1253383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Background Described for the first time in 1954, Jeune syndrome (JS), often called asphyxiating thoracic dystrophy, is a congenital musculoskeletal disease characterized by short ribs, a narrow thorax, and small limbs. In this study, we analyzed and presented our preliminary experience with a device for progressive internal distraction of the sternum (PIDS) in patients with symptomatic JS. In addition, we reviewed the contemporary English literature on existing surgical techniques for treating children with congenital JS. Material and methods A retrospective analysis of pediatric patients (<18 years old) treated for symptomatic JS at our tertiary center between 2017 and 2023 was performed. Results We presented two patients with JS who underwent surgery using an internal sternal distractor, a Zurich II Micro Zurich Modular Distractor, placed at the corpus of the sternum among the divided halves. Conclusions We obtained promising results regarding the safety and effectiveness of this less-invasive device for PIDS in patients with symptomatic JS. Further studies on long-term outcomes are needed to validate these findings.
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Affiliation(s)
- Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina Martucci
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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