The MRI Findings of the Right-Sided Fetal Lung Can Be Used to Predict Postnatal Mortality and the Requirement for Extracorporeal Membrane Oxygenation in Isolated Left-Sided Congenital Diaphragmatic Hernia

Abstract

Abbreviations: CDH, congenital diaphragmatic hernia; ECMO, extracorporeal membrane oxygen; ERFLV, expected right fetal lung volume; FETO, fetal endoscopic tracheal occlusion; FLV, fetal lung volume; HFO, highfrequency oscillation ventilation; INO, inhaled nitric oxide; NPV, negative predictive value; %RFLV, the ratio of observed right-sided fetal lung volume to the expected right-sided fetal lung volume; PPHN, persistent pulmonary hypertension of newborn; PPV, positive predictive value 0031-3998/07/6201-0093 PEDIATRIC RESEARCH

Amniotic lamellar body count and congenital diaphragmatic hernia in humans and in a rat model

“…The FLV prediction using MRI has been reported to be accurate (12,13), but absolute FLV alone is not predictive of outcome because increasing lung volume with increasing gestational age could be a confounding factor (14). Therefore, percentage of FLV on MRI is considered to be a more useful predictor in CDH (15). In the current study, percentage of FLV on MRI, not absolute FLV, differed significantly in terms of the prediction of mortality in CDH.…”

“…We calculated the percentage of right sided FLV, defined as the ratio of the observed right FLV to the expected right FLV, using MRI (Visart EX 1.5T; Toshiba, Tokyo, Japan), as described by Hayakawa et al (15). We also evaluated whether the right-sided pulmonary baseline was completely present.…”

MR prediction of postnatal outcomes in left‐sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume

“…A few fetuses with right-sided CDH were excluded from this study because we considered it inappropriate to use the contralateral FLV for a regression analysis of the FLV in the control group due to the difference in actual volume between the right and left lungs (21). Recently, Hayakawa et al (4) reported that the relative right FLV is a good predictor of postnatal mortality and requirement of ECMO in left-sided CDH. The results of the present study also support this hypothesis.…”

“…Although ultrasound reveals the vast majority of clinically significant fetal anomalies, accurate prediction of lung development and maturity with ultrasound remains somewhat challenging (3). In contrast, magnetic resonance (MR) imaging has become increasingly popular for prenatal diagnosis (4), and recently developed fast MR sequences provide more anatomical information and, potentially, more functional details of the malformed fetus (5). Accordingly, there has been an increase in the number of reports discussing the potential of MR imaging for assessment of the fetal lung.…”

“…FLV increases with gestational age (GA) (3,4) and is a potential predictor of pulmonary hypoplasia (6,7). FLV is also reported to be related to postnatal outcomes and the need for neonatal intensive care in CDH (4,6 -11), although some articles state that FLV does not match postnatal outcomes (12,13).…”