Fetal lung volume measurement by magnetic resonance imaging in congenital diaphragmatic hernia.
OBJECTIVE
To study the potential for prenatal magnetic resonance imaging to predict pulmonary hypoplasia in congenital diaphragmatic hernia.


METHODS
Prospective observational study.


METHODS
Tertiary care centre.


METHODS
Thirteen cases of congenital diaphragmatic hernia (11 left, 2 right) without associated anomalies and 74 controls.


METHODS
Measurements by magnetic resonance imaging of fetal lung volume were achieved. In the control fetuses, a regression analysis was performed to associate fetal lung volume with gestational age. This yielded a formula allowing calculation of the expected fetal lung volume as a function of gestational age. In the cases with congenital diaphragmatic hernia, the observed/expected fetal lung volume ratio was compared with perinatal outcome.


METHODS
Neonatal mortality and pulmonary hypoplasia, which was defined as lung/body weight ratios less than 0.012.


RESULTS
The expected fetal lung volume was derived from the following formula: Fetal lung volume (mL) = exp (1.24722 + 0.08939 x gestational age in weeks). The observed/expected fetal lung volume ratio was significantly lower in congenital diaphragmatic hernia (median: 0.31, range: 0.06-0.63), than in controls (median: 0.99, range: 0.42-1.94). This ratio was significantly less in the infants with congenital diaphragmatic hernia who died (median: 0.26, range: 0.06-0.63) compared with those who survived (median: 0.46, range: 0.35-0.56). The observed: expected fetal lung volume ratio was significantly correlated with the post mortem lung: body weight ratio.


CONCLUSIONS
In isolated congenital diaphragmatic hernia, fetal lung volume measurement by magnetic resonance imaging is a potential predictor of pulmonary hypoplasia and postnatal outcome. Further studies are required to establish the clinical value of magnetic resonance imaging for the prenatal assessment of fetal lungs.
Mahieu-Caputo
D
D
Necker Hospital for Sick Children, Paris, France.
Sonigo
P
P
Dommergues
M
M
Fournet
J C
JC
Thalabard
J C
JC
Abarca
C
C
Benachi
A
A
Brunelle
F
F
Dumez
Y
Y
D016022:Case-Control Studies; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006548:Hernia, Diaphragmatic / Q000175:diagnosis; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008168:Lung / Q000473:pathology*; D008176:Lung Volume Measurements / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods; D011446:Prospective Studies