Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume.
OBJECTIVE
To investigate the correlation between fetal lung volume (FLV), measured with magnetic resonance imaging (MRI), and postnatal mortality in newborns with prenatally diagnosed isolated congenital diaphragmatic hernia (CDH).


METHODS
In a 4-year prospective multicenter study, 77 fetuses with isolated CDH diagnosed between 20 and 33 weeks' gestation underwent fast spin-echo T2-weighted lung MRI. These MRI-FLV measurements were compared with a previously published normative curve obtained in 215 fetuses without thoracoabdominal malformations and with normal ultrasound biometric findings. FLV measurements were correlated with postnatal survival. The mean gestational age at MRI was 31.3 weeks.


RESULTS
The measured/expected FLV ratio was significantly lower in the newborns with CDH who died compared with those who survived (23.6 +/- 12.2 vs. 36.1 +/- 13.0, P < 0.001). When the ratio was below 25%, there was a significant decrease in postnatal survival (19% vs. 40.3%, P = 0.008). Survival was significantly lower for neonates when one lung could not be seen by fetal MRI compared with those fetuses with two visible lungs on MRI (17.9% vs. 62.1%, P < 0.001).


CONCLUSIONS
In isolated CDH, FLV measurement by MRI is a good predictor of postnatal mortality due to pulmonary hypoplasia.
Gorincour
G
G
Department of Pediatric Radiology, La Timone Children's Hospital, Marseilles, France. guillaume.gorincour@mail.ap-hm.fr
Bouvenot
J
J
Mourot
M G
MG
Sonigo
P
P
Chaumoitre
K
K
Garel
C
C
Guibaud
L
L
Rypens
F
F
Avni
F
F
Cassart
M
M
Maugey-Laulom
B
B
Bourlière-Najean
B
B
Brunelle
F
F
Durand
C
C
Eurin
D
D
D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000196:embryology* / Q000473:pathology; D008176:Lung Volume Measurements / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis