Ultrasonographic assessment of mediastinal shift angle (MSA) in isolated left congenital diaphragmatic hernia for the prediction of postnatal survival

Romiti, A; Viggiano, M.; Conforti, Andrea; Valfrè, Laura; Ravà, Lucilla; Atti, Marta Luisa Ciofi degli; Bagolan, Pietro; Caforio, Leonardo

doi:10.1080/14767058.2018.1517329

Cited by 13 publications

(14 citation statements)

References 22 publications

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“…In the study we demonstrated a high reproducibility, and that the MSA was lower in fetuses with normal lungs. As in the US study of Romiti, the MSA was also proportional to the severity of the CDH based on survival rate.…”

Section: Discussionmentioning

confidence: 78%

“…This measurement, to the best of our knowledge earlier determined only through prenatal ultrasound by Romiti et al, may hold promise also for fetal MRI. Based on this assumption and on the ease and reproducibility of the MSA on ultrasound, the aim of our study was to quantify the angle of the mediastinal shift also by fetal MRI and use it as an indirect measure of pulmonary hypoplasia and fetal lung volume and verify whether MSA is a prognostic factor in left CDH.…”

Section: Introductionmentioning

confidence: 80%

“…We aimed to assess if MSA measurement, recently introduced as an US based measure of severity of isolated left CDH, could be used also with fetal MRI as an indicator that can be faster obtained.…”

Section: Discussionmentioning

confidence: 99%

“…The MSA was measured as previously described for ultrasound by Romiti et al after selecting an axial TRUFI image at the level of four‐chamber view of the fetal heart. A sagittal midline landmark line was drawn from the posterior face of the vertebral body to the mid posterior surface of the sternum.…”

Section: Methodsmentioning

confidence: 99%

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Fetal MRI assessment of mediastinal shift angle in isolated left congenital diaphragmatic hernia: A new postnatal survival predictive tool?

et al. 2019

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Objective: To quantify the mediastinal shift angle (MSA) in fetuses with isolated left congenital diaphragmatic hernia (CDH) by magnetic resonance imaging and evaluate survival.Method: Fetuses from singleton pregnancies with isolated left CDH were matched for gestational age with controls without thoracic malformations. For all fetuses the MSA was determined by two operators and inter-operator variability and differences between cases and controls were investigated. For all cases total fetal lung volume (TFLV) was calculated and the correlation between MSA and TFLV was assessed, and its predictive value towards survival was determined.Results: Thirty-four fetuses were included as cases and 42 as controls. The mean gestational age for assessment of CDH fetuses was 32 weeks (range 27-38). Twentyfour fetuses survived until discharge and 10 did not. There was an excellent interoperator reliability for measuring the MSA and a significant difference between MSA in cases and controls. There was an inverse correlation between MSA values and survival, a correlation between TFLV and survival and an inverse correlation between MSA and TFLV. The area under the ROC curve for MSA in predicting survival was 0.931 (95% CI 0.851-1.000).Conclusion: The MSA measured late in gestation correlates with postnatal survival in patients with isolated left CDH.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Fetal MRI assessment of mediastinal shift angle in isolated left congenital diaphragmatic hernia: A new postnatal survival predictive tool?

et al. 2019

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“…A sagittal midline landmark line will be drawn from the posterior face of the vertebral body to the mid of the posterior surface of the sternum, dividing the fetal thorax into two symmetric parts. A second landmark line will be traced from the same vertebral point, representing the angle vertex, tangentially to the external wall of the right atrium [ 69 , 71 , 76 , 77 ]. The software will automatically calculate the corresponding MSA.…”

Section: Methods and Analysismentioning

confidence: 99%

A maChine and deep Learning Approach to predict pulmoNary hyperteNsIon in newbornS with congenital diaphragmatic Hernia (CLANNISH): Protocol for a retrospective study

et al. 2021

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Introduction Outcome predictions of patients with congenital diaphragmatic hernia (CDH) still have some limitations in the prenatal estimate of postnatal pulmonary hypertension (PH). We propose applying Machine Learning (ML), and Deep Learning (DL) approaches to fetuses and newborns with CDH to develop forecasting models in prenatal epoch, based on the integrated analysis of clinical data, to provide neonatal PH as the first outcome and, possibly: favorable response to fetal endoscopic tracheal occlusion (FETO), need for Extracorporeal Membrane Oxygenation (ECMO), survival to ECMO, and death. Moreover, we plan to produce a (semi)automatic fetus lung segmentation system in Magnetic Resonance Imaging (MRI), which will be useful during project implementation but will also be an important tool itself to standardize lung volume measures for CDH fetuses. Methods and analytics Patients with isolated CDH from singleton pregnancies will be enrolled, whose prenatal checks were performed at the Fetal Surgery Unit of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (Milan, Italy) from the 30th week of gestation. A retrospective data collection of clinical and radiological variables from newborns’ and mothers’ clinical records will be performed for eligible patients born between 01/01/2012 and 31/12/2020. The native sequences from fetal magnetic resonance imaging (MRI) will be collected. Data from different sources will be integrated and analyzed using ML and DL, and forecasting algorithms will be developed for each outcome. Methods of data augmentation and dimensionality reduction (feature selection and extraction) will be employed to increase sample size and avoid overfitting. A software system for automatic fetal lung volume segmentation in MRI based on the DL 3D U-NET approach will also be developed. Ethics and dissemination This retrospective study received approval from the local ethics committee (Milan Area 2, Italy). The development of predictive models in CDH outcomes will provide a key contribution in disease prediction, early targeted interventions, and personalized management, with an overall improvement in care quality, resource allocation, healthcare, and family savings. Our findings will be validated in a future prospective multicenter cohort study. Registration The study was registered at ClinicalTrials.gov with the identifier NCT04609163.

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Ultrasonographic measurement of mediastinal shift angle for the prediction of postnatal survival in fetuses with isolated left congenital diaphragmatic hernia

Rosales,

Flores

2024

Intl J Gynecology & Obste

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ObjectiveThe main objective of the study was to determine if ultrasonographic measurement of mediastinal shift angle (MSA) can predict postnatal survival in fetuses with isolated left congenital diaphragmatic hernia (CDH). This relatively new technique may be used to enhance antenatal prediction of survival in fetuses with CDH.MethodsA retrospective cross‐sectional study was conducted at the Philippine Children's Medical Center involving 16 cases with prenatally diagnosed isolated left CDH and 60 controls with normal fetuses. The cases with prenatally diagnosed isolated left CDH were allocated into two groups: Group A (survivors) and group B (non‐survivors). For all fetuses (study and control groups), MSA was determined independently by two operators. The diagnostic capacity of MSA was assessed using the receiver operating characteristic curve.ResultsThe mean MSA for the control group was 17.18°. Among CDH cases, the mean MSA was 33.04° and 37.57° for survivors and non‐survivors, respectively. Results showed that MSA significantly predicted the probability of neonatal survival status (OR = 0.46, P = 0.021). The best cutoff score of MSA based on the receiver operating characteristic curve was 33.80° with 87.50% sensitivity and specificity.ConclusionMSA has the potential to enhance antenatal prediction of survival in fetuses with CDH and may serve as a guide in prenatal counseling and evaluation of the need for in‐utero treatment or postnatal procedures.

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Ultrasonographic assessment of mediastinal shift angle (MSA) in isolated left congenital diaphragmatic hernia for the prediction of postnatal survival

Abstract: In fetuses with isolated CDH, the mediastinal shift may be quantified using mediastinal shift angle (MSA) and this US marker, similarly to the widely accepted and used US prenatal prognostic indicators (LHR and O/E LHR), seems to reliably predict survival.

Cited by 13 publications

References 22 publications

Fetal MRI assessment of mediastinal shift angle in isolated left congenital diaphragmatic hernia: A new postnatal survival predictive tool?

Fetal MRI assessment of mediastinal shift angle in isolated left congenital diaphragmatic hernia: A new postnatal survival predictive tool?

A maChine and deep Learning Approach to predict pulmoNary hyperteNsIon in newbornS with congenital diaphragmatic Hernia (CLANNISH): Protocol for a retrospective study

Ultrasonographic measurement of mediastinal shift angle for the prediction of postnatal survival in fetuses with isolated left congenital diaphragmatic hernia

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