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.
We evaluated whether a correlation existed between fetal pulmonary magnetic resonance imaging (MRI) findings and postnatal mortality, as well as the requirements for extracorporeal membrane oxygenation (ECMO) in infants with prenatally diagnosed, isolated left-sided congenital diaphragmatic hernia (CDH). Twenty-one pregnant women carrying fetuses with CDH underwent 30 MRI scans, and the right-sided fetal lung volume (FLV) was measured. In the control, a regression analysis was performed to associate FLV with gestational age. This yielded a formula that enabled the calculation of the expected right fetal lung volume (ERFLV). In cases with CDH, the right-sided observed FLV/ERFLV (= %RFLV) was compared with both the postnatal mortality and whether ECMO was required. Additionally, we investigated the relationship between the lung shape on MRI (whether there was a complete pulmonary baseline present) and postnatal mortality. The %RFLV was significantly lower in nonsurvivors compared with survivors. Among survivors, the %RFLV was significantly lower in infants who required ECMO compared with those who did not. The pulmonary baseline was completely present in 3 (38%) and 13 (100%) of the nonsurvivors and survivors, respectively. In isolated left-sided CDH, the %RFLV is a good predictor not only of postnatal mortality but also of the requirement for ECMO.
Hayakawa
Masahiro
M
Maternity and Perinatal Care Center, Nagoya University Hospital, Nagoya, Aichi-prefecture, 466-8550 Japan. masahaya@med.nagoya-u.ac.jp
Seo
Takahiko
T
Itakua
Atsuo
A
Hayashi
Seiji
S
Miyauchi
Megumi
M
Sato
Yoshiaki
Y
Saito
Akiko
A
Nakayama
Atsushi
A
Takemoto
Koji
K
Hasegawa
Masayuki
M
Kaneko
Kenitiro
K
Okada
Mayumi
M
Hayakawa
Hiromi
H
Sumigama
Seiji
S
Kikkawa
Fumitaka
F
Ando
Hisami
H
Kojima
Seiji
S
D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D005313:Fetal Death; D005333:Fetus / Q000033:anatomy & histology*; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008168:Lung / Q000033:anatomy & histology* / Q000196:embryology; D008279:Magnetic Resonance Imaging; D010100:Oxygen / Q000378:metabolism; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D013223:Statistics as Topic; D015996:Survival Rate
D010100:Oxygen