Percent predicted lung volumes as measured on fetal magnetic resonance imaging: a useful biometric parameter for risk stratification in congenital diaphragmatic hernia.
OBJECTIVE
This study was aimed at determining whether a new method of analyzing lung volumes on fetal magnetic resonance (MR) imaging could be used to predict the degree of pulmonary compromise in congenital diaphragmatic hernia (CDH).


METHODS
Seventeen fetuses with CDH were prospectively evaluated by MR. Lung volumes were measured using an established technique and expressed as a percentage of the predicted lung volume (PPLV). Predicted lung volume was determined by subtracting measured mediastinal volume from total measured thoracic volume. The PPLV was correlated with postnatal outcomes. Statistical analyses were performed using the Mann-Whitney, Spearman correlation, or Fisher exact tests (P < .05).


RESULTS
Of the 14 liveborn patients, the PPLV was 20.3+/-10.4 (gestational age at MR, 22.3 +/- 5.7 weeks). The PPLV was significantly associated with extracorporeal membrane oxygenation (ECMO) use, hospital length of stay, and survival. All patients with a PPLV of less than 15 required prolonged ECMO support and had a 40% survival rate. In contrast, only 11% of patients with a PPLV of greater than 15 required ECMO, and survival was 100%.


CONCLUSIONS
The PPLV as measured by fetal MR imaging can accurately predict disease severity in CDH. A value of less than 15 is associated with a significantly higher risk for prolonged support and/or death, despite aggressive postnatal management.
Barnewolt
Carol E
CE
Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Kunisaki
Shaun M
SM
Fauza
Dario O
DO
Nemes
Luanne P
LP
Estroff
Judy A
JA
Jennings
Russell W
RW
D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment