Fetal magnetic resonance imaging in isolated diaphragmatic hernia: volume of herniated liver and neonatal outcome.
OBJECTIVE
We sought to use magnetic resonance (MR) imaging (MRI) to estimate percentage of fetal thorax occupied by lung, liver, and other abdominal organs in pregnancies with congenital diaphragmatic hernia (CDH).


METHODS
This was a retrospective study of pregnancies with isolated CDH referred for MRI between August 2000 and June 2006. Four regions of interest were measured in the axial plane by an investigator blinded to neonatal outcome, and volumes were then calculated. The percentages of thorax occupied by lung, liver, and all herniated organs were then compared with neonatal outcomes.


RESULTS
Fifteen CDH fetuses underwent MRI at a median gestational age of 29 weeks. Liver herniation was found in 93%. When the liver occupied > 20% of the fetal thorax, neonatal deaths were significantly increased. Percentages of lung and other herniated organs were not associated with outcome.


CONCLUSIONS
In our MR series of isolated CDH, neonatal deaths were significantly increased when > 20% of the fetal thorax was occupied by liver.
Worley
Kevin C
KC
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA. kevin.worley@mac.com
Dashe
Jodi S
JS
Barber
Robert G
RG
Megison
Stephen M
SM
McIntire
Donald D
DD
Twickler
Diane M
DM
D030022:Aristolochia; D005260:Female; D005313:Fetal Death / Q000473:pathology; D006547:Hernia / Q000151:congenital / Q000401:mortality / Q000473:pathology*; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000473:pathology; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000295:instrumentation / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies