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Preoperative delineation of pulmonary fissural anatomy at multi-detector computed tomography in children with congenital pulmonary malformations and impact on surgical complications and postoperative course

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Abstract

Background

Delineation of the anatomy and integrity of the pulmonary fissures at CT is important because anomalous or incomplete fissures might increase the risk of surgery and of postoperative complications.

Objective

To preoperatively evaluate the integrity of the pleural fissures in children with congenital lung malformations and determine whether anomalous fissural anatomy is a risk factor for a more complicated surgery and postoperative course.

Materials and methods

We reviewed preoperative multi-detector CT scans of consecutive children who underwent open or thoracoscopic resection of a congenital pulmonary malformation from 2008 to 2018, to determine the integrity of the fissural anatomy, and compared these findings with the surgical report. We correlated postoperative factors including operating room time, days in hospital and chest tube with the operating room documented fissural integrity.

Results

We saw a significant association between the radiologically determined fissural integrity at CT and the operative findings independently for the right, left and both lungs combined (P<0.001). The sensitivity of CT to determine fissural integrity was 76.9%, specificity 95.2%, positive predictive value 95.2%, negative predictive value 76.9%, and accuracy 85.1%. There was a statistically significant association between size of the pulmonary malformation and the integrity of the fissure(s) (P=0.024). Larger lesions also resulted in a significantly longer hospitalization (P=0.024).

Conclusion

Chest CT showed high accuracy for delineating fissural anatomy in children with congenital pulmonary malformations, with a good interobserver correlation. Incomplete lung fissures were found more often in children with larger congenital pulmonary malformations. In addition, larger lesions were associated with longer hospital stays. Therefore, children with incomplete fissures may have a longer postoperative course. Analysis of the fissural anatomy should be included in the CT report.

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Acknowledgments

The authors would like to acknowledge the support of Ontasian Imaging Lab (OIL).

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    María Navallas, Afsaneh Amirabadi & David E. Manson

  2. Department of Medical Imaging, Division of Pediatric Imaging, University of Toronto, Toronto, ON, Canada

    María Navallas, Afsaneh Amirabadi & David E. Manson

  3. Department of Pediatric Surgery, Hospital for Sick Children, Toronto, ON, Canada

    Priscilla Chiu

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  1. María Navallas
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Correspondence to María Navallas.

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Navallas, M., Chiu, P., Amirabadi, A. et al. Preoperative delineation of pulmonary fissural anatomy at multi-detector computed tomography in children with congenital pulmonary malformations and impact on surgical complications and postoperative course. Pediatr Radiol 50, 636–645 (2020). https://doi.org/10.1007/s00247-020-04618-z

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  • DOI: https://doi.org/10.1007/s00247-020-04618-z

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