Fetal MR lung volumetry in congenital diaphragmatic hernia (CDH): prediction of clinical outcome and the need for extracorporeal membrane oxygenation (ECMO).
BACKGROUND
Despite the ultrasound (US) based lung-to-head ratio (LHR) and first results of fetal lung volume (FLV) determination in magnetic resonance imaging (MRI), there is no reliable prenatal parameter for the clinical course and outcome of fetuses with congenital diaphragmatic hernia (CDH), in particular for the need of extracorporeal membrane oxygenation (ECMO).


METHODS
MR FLV measurement was evaluated in 36 fetuses with CDH using T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) imaging. FLV and liver herniation, respectively, were correlated with survival and the need for ECMO therapy. A total of 18 healthy fetuses served as controls. MR FLV measurement was applied to predict survival and the need for neonatal ECMO therapy and to assess liver herniation as a prognostic parameter.


RESULTS
On MRI there was a highly significant correlation of the FLV and patients' survival (p=0.0001) and ECMO requirement, respectively (p=0.0029). Compared to normal controls mean FLV in infants who died was 10% (9.4+/-5.8 ml) and 32% in surviving infants (25+/-9.7 ml). Liver herniation significantly decreased lung volume and negatively impacted clinical outcome (p<0.0005).


CONCLUSIONS
The MR FLV is a strong predictor of survival in CDH patients. MR FLV measurements are also valuable to identify patients who may benefit from ECMO therapy. Upward liver herniation is the most important additional prognostic parameter.
Kilian
A K
AK
Institut für Klinische Radiologie und Nuklearmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim, Mannheim, Germany.
Büsing
K-A
KA
Schuetz
E-M
EM
Schaible
T
T
Neff
K W
KW
D000015:Abnormalities, Multiple / Q000175:diagnosis; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005583:Fourier Analysis; D006548:Hernia, Diaphragmatic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000196:embryology; D008168:Lung / Q000002:abnormalities* / Q000473:pathology; D008176:Lung Volume Measurements / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009929:Organ Size / Q000502:physiology; D010100:Oxygen / Q000097:blood; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis / Q000379:methods*; D011379:Prognosis; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D015996:Survival Rate; D016216:Ultrasonography, Prenatal
D010100:Oxygen