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

Abstract

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

Separate Evaluation of the Ipsilateral and Contralateral MR Fetal Lung Volume in Patients With Congenital Diaphragmatic Hernia

“…The mortality rate for fetuses with severe CDH in their study was 52%; ECMO therapy was required in 62% of cases. In patients with mild CDH (total observed-to-expected MR FLV above 32%), mortality rate was only 8% and only 13% of patients needed ECMO therapy [16]. According to Zamora et al [17], a cutoff value of 35% for total observed-to-expected MR FLV yielded a sensitivity of 72% and a specificity of 65% for predicting development of CLD [17].…”

“…Various studies have found that the observed-to-expected MR FLV of both lungs is a reliable prognostic parameter of survival, need for extracorporeal membrane oxygenation (ECMO), and development of chronic lung disease (CLD) [14][15][16][17]. For example, Ruano et al [16] defined severe CDH as total observed-to-expected MR FLV (i.e., in both lungs combined) below 32%.…”

“…For example, Ruano et al [16] defined severe CDH as total observed-to-expected MR FLV (i.e., in both lungs combined) below 32%. The mortality rate for fetuses with severe CDH in their study was 52%; ECMO therapy was required in 62% of cases.…”

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

“…11,20 However, an advantage of antenatal MRI is the identification and quantification of liver herniation which, when combined with observed-to-expected total fetal lung volume, improves prediction characteristics. 17 Thus, MRI may have additional value where available, especially in those cases where the observed-toexpected lung-head ratio on ultrasound shows moderate or severe CDH.…”

Improving the Prediction of Neonatal Outcomes in Isolated Left‐Sided Congenital Diaphragmatic Hernia by Direct and Indirect Sonographic Assessment of Liver Herniation

“…[7][8][9] Studies have shown that the amount of liver herniation can be measured on magnetic resonance imaging and is an independent prognostic factor. [10][11][12] A recent study demonstrated that the amount of liver herniation can be assessed directly on 2-dimensional sonography in the same image that is used to measure the lung-to-head ratio (lung size) by calculating the liver-to-thoracic area ratio. 13 Investigators have also shown that the stomach position in the fetal chest can be considered an indirect method to quantify the degree of liver herniation, which also correlates with prognosis.…”