Magnetic Resonance-based Morphological Features of the Manubrium and the Surgeons' View Line: When to Use Manubriotomy?

OBJECTIVE: To identify morphological features of the relationship between the manubrium and vertebrae of the cervicothoracic junction for use in guidelines for the selection of the appropriate surgical approach.

METHODS: A review of 222 midsagittal section MR scans was conducted. The surgeons' view line was parallel to the inferior caudal vertebral endplate. Morphometric measurement of the manubrium and the cervicothoracic junction's vertebral body included the distance from the highest point of the manubrium to the surgeons' view line and the angle between that line to the horizontal.

RESULTS: A significant difference was found with regard to the distance between groups (P < 0.001). A significant difference between males and females was also identified. The lowest level above the manubrium was the T1. Between groups, the angles were significantly different (P ≤ 0.01). Males showed a larger angle than females with respect to Groups C6, C7, T1 (P < 0.001), and T2 (P = 0.007). In terms of both the distance and angle, no significant difference was determined according to age (P > 0.05).

CONCLUSION: Our investigation provides insight into the anatomy of the manubrium and vertebrae of the cervicothoracic junction, and further shows that, for the majority of people, the T1 forms the boundary of the manubriotomy. We found that both the distance and angle differed significantly according to sex. A better understanding of the radiological anatomy of the surgeons' view line will help in the preoperative assessment of patients, as well as indicating an appropriate surgical approach.