Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia

被引：122

作者：

Ruano, R. ^{[1
,2
]}

Lazar, D. A. ^{[1
,3
]}

Cass, D. L. ^{[1
,3
]}

Zamora, I. J. ^{[1
,3
]}

Lee, T. C. ^{[1
,3
]}

Cassady, C. I. ^{[1
,4
]}

Mehollin-Ray, A. ^{[1
,4
]}

Welty, S. ^{[1
,5
]}

Fernandes, C. J. ^{[1
,5
]}

Haeri, S. ^{[1
,2
]}

Belfort, M. A. ^{[1
,2
]}

Olutoye, O. O. ^{[1
,3
]}

机构：

[1] Texas Childrens Hosp, Texas Childrens Fetal Ctr, Houston, TX 77030 USA

[2] Baylor Coll Med, Dept Obstet & Gynecol, Houston, TX 77030 USA

[3] Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX 77030 USA

[4] Baylor Coll Med, Dept Radiol, Houston, TX 77030 USA

[5] Baylor Coll Med, Dept Pediat, Sect Neonatol, Houston, TX 77030 USA

来源：

ULTRASOUND IN OBSTETRICS & GYNECOLOGY | 2014年 / 43卷 / 06期

关键词：

congenital diaphragmatic hernia; diaphragm hernia outcomes; fetal lung volumes; fetal ultrasound; liver herniation; lung-to-head ratio; magnetic resonance imaging; prenatal diagnosis; prenatal predictors; OPERATING CHARACTERISTIC CURVES; ENDOSCOPIC TRACHEAL OCCLUSION; 3-DIMENSIONAL ULTRASONOGRAPHY; PULMONARY HYPOPLASIA; PRENATAL PREDICTION; SURVIVAL; FETUSES; RATIO; MANAGEMENT; POSITION;

D O I：

10.1002/uog.13223

中图分类号：

O42 [声学];

学科分类号：

070206 ; 082403 ;

摘要：

Objective To determine associations between fetal lung and liver herniation volumes measured by magnetic resonance imaging (MRI) and mortality/need for extracorporeal membrane oxygenation (ECMO) in cases of isolated congenital diaphragmatic hernia (CDH). A secondary objective was to compare prenatal MRI parameters with two-dimensional ultrasound lung measurements. Methods A retrospective review of medical records of all fetuses with isolated CDH evaluated between January 2004 and July 2012 was performed. The following MRI parameters were measured at 20-32 weeks: observed/expected total fetal lung volume (o/e-TLV), predicted pulmonary volume (PPV), percentage of liver herniated into the fetal thorax (%LH) and the liver/thoracic volume ratio (LiTR). These were compared with the ultrasound-determined lung-to-head ratio (LHR) and the observed/expected LHR (o/e-LHR) in the same cohort. The predictive value of MRI and ultrasound parameters for mortality and the need for ECMO was evaluated by univariate, multivariate and factor analysis and by receiver-operating characteristics curves. Results Eighty fetuses with isolated CDH were evaluated. Overall mortality was 18/80 (22.5%). Two newborns died a few hours after birth. ECMO was performed in 29/78 (37.2%) newborns, with a survival rate of 48.3% (14/29). The side of the diaphragmatic defect was not associated with mortality (P = 0.99) or the need for ECMO(P = 0.48). Good correlation was observed among o/e-TLV, PPV, LHR and o/e-LHR as well as between %LH and LiTR (r = 0.89; P < 0.01); however, fetal lung measurements and measures of liver herniation were not correlated (all P > 0.05). All parameters were statistically associated with mortality or the need for ECMO. The best combination of measurements to predict mortality was o/e-TLV and %LH, with 83% accuracy. Conclusion Mortality and the need for ECMO in neonates with isolated CDH can be best predicted using a combination of MRI o/e-TLV and %LH. Copyright (C) 2013 ISUOG. Published by John Wiley & Sons Ltd.

引用

页码：662 / 669

页数：8

共 40 条

[1] Percent predicted lung volumes as measured on fetal magnetic resonance imaging: a useful biometric parameter for risk stratification in congenital diaphragmatic hernia [J].