Fetal Cervical Teratoma: What Is the Role of Fetal MRI in Predicting Pulmonary Hypoplasia?

Abstract

Objective: To determine whether total fetal lung volumes estimated by MRI could predict lethal pulmonary hypoplasia in a cohort of fetuses with cervical teratomas. Methods: We performed a retrospective cohort study of fetal cervical teratomas from January 1, 2005, through April 1, 2012. The primary outcome was the ability of total lung volumes measured by MRI to predict neonatal mortality specifically due to pulmonary hypoplasia. Measured lung volumes were compared to previously reported normal values. The percent of observed-to-expected lung volume and the percent predicted lung volume were calculated. The positive and negative predictive values were calculated for each variable. Results: Fetal MRI-derived total lung volumes 1 standard deviation below the median for gestational age had a positive predictive value of 100% in predicting lethal pulmonary hypoplasia. Conversely, total lung volumes above this level were uniformly associated with pulmonary survival (100% negative predictive value). Additionally, percent predicted lung volume ≤75.7 and observed-to-expected lung volume ≤68.3 were associated with lethal pulmonary hypoplasia. Conclusion: In this small cohort, MRI-estimated lung volumes were helpful in predicting the presence of pulmonary hypoplasia complicating fetal cervical teratoma.

Predictive value of fetal lung volume in prenatally diagnosed skeletal dysplasia

“…This study demonstrates a significant association between low O/E TLV for gestational age and lethality in a cohort of 23 pregnancies with prenatally diagnosed skeletal dysplasia. Low‐measured lung volume for gestational age has previously been shown to correlate with poor outcome in fetuses with congenital diaphragmatic hernia (CDH) and cervical teratoma . Pulmonary hypoplasia in these conditions is related to herniation of abdominal contents into the thoracic cavity in the case of diaphragmatic hernia and to airway distortion with resultant lung compression in the case of giant cervical teratoma .…”

“…Although there are no formally published guidelines for when to perform fetal MRI, the most common reasons include evaluation of central nervous system anomalies, fetal masses such as teratomas, and pulmonary anomalies such as congenital pulmonary airway malformation or pulmonary hypoplasia . Comparison of fetal lung volumes measured by MRI with expected lung volume for gestational age has been shown to be predictive of survival in fetuses with congenital diaphragmatic hernia and cervical teratoma . Additionally, fetal MRI provides better resolution of the fetal brain and can define complex brain malformations more precisely than ultrasound …”

“…2 Comparison of fetal lung volumes measured by MRI with expected lung volume for gestational age has been shown to be predictive of survival in fetuses with congenital diaphragmatic hernia and cervical teratoma. 3,4 Additionally, fetal MRI provides better resolution of the fetal brain and can define complex brain malformations more precisely than ultrasound. 5 The utility of two-dimensional ultrasound imaging for prediction of diagnosis and prognosis of fetuses with prenatally diagnosed skeletal dysplasia has been well established.…”

Fetal neck tumors – antenatal and intrapartum management

“…Secondly, they may affect the patency of fetal airways, including trachea, which may have fatal consequences after birth. In addition, big neck tumors, especially teratomas, may cause fetal lung hypoplasia, because of wedging the lungs into the apices of chest cavity [2]. Finally, they have great cosmetic effect on the child.…”

“…A differential diagnosis of the fetal neck tumor or cystic lesions include lymphangioma, haemangioma, goiter, teratoma and neuroblastoma [2,3].…”