Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging.
OBJECTIVE
To investigate developmental changes in the apparently unaffected contralateral lung by using signal intensity ratios (SIR) and lung volumes (LV), and to search for correlation with clinical outcome.


METHODS
Twenty-five fetuses (22-37 weeks' gestation) were examined. Lung/liver signal intensity ratios (LLSIR) were assessed on T1-weighted and T2-weighted sequences for both lungs, then together with LV compared with age-matched controls of 91 fetuses by using the U test. Differences in LLSIRs and lung volumes were correlated with neonatal outcomes.


RESULTS
LLSIRs in fetuses with congenital diaphragmatic hernia (CDH) were significantly higher in both lungs on T1-weighted images and significantly lower on T2-weighted images, compared with normals (p < 0.05), increasing on T2-weighted imaging and decreasing on T1-weighted imaging during gestation. Total LV were significantly smaller in the CDH group than in controls (p < 0.05). No significant differences in LLSIR of the two lungs were found. Outcomes correlated significantly with total LV, but not with LLSIR.


CONCLUSIONS
Changes in LLSIR seem to reflect developmental impairment in CDH; however, they provide no additional information in predicting outcome. LV remains the best indicator on fetal MR imaging of neonatal survival in isolated, left-sided CDH.
Balassy
Csilla
C
Department of Radiology, Medical University of Vienna, Vienna, Austria. csilla.balassy@meduniwien.ac.at
Kasprian
Gregor
G
Brugger
Peter C
PC
Weber
Michael
M
Csapo
Bence
B
Herold
Christian
C
Prayer
Daniela
D
D000465:Algorithms; D005260:Female; D006548:Hernia, Diaphragmatic / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008168:Lung / Q000196:embryology / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011296:Prenatal Diagnosis / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity