Reliability of the lung to thorax transverse area ratio as a predictive parameter in fetuses with congenital diaphragmatic hernia.
OBJECTIVE
An accurate prenatal assessment of the patients' severity is essential for the optimal treatment of individuals with congenital diaphragmatic hernia (CDH). The purpose of this study was to clarify the reliability of the lung to thorax transverse area ratio (L/T) as a prenatal predictive parameter.


METHODS
A multicenter retrospective cohort study was conducted on 114 isolated CDH fetuses with a prenatal diagnosis during the period between 2002 and 2007 at five participating centers in Japan. The relationship between the gestational age and the L/T was analyzed. The most powerful measurement point and accurate cutoff value of the L/T was determined by an analysis of a receiver operating characteristic curve, which was verified by comparing the patients' severity.


RESULTS
There was a negative correlation between the gestational age and the L/T in the non-survivors, and no correlation in the survivors. There were significant differences in the parameters which represented the patients' severity including the respiratory and circulatory status, the surgical findings, and the final outcomes between the groups divided at 0.080 in the minimum value of the L/T during gestation.


CONCLUSIONS
The L/T was not strongly influenced by the gestational age, and it was found to be a reliable prenatal predictive parameter in fetuses with isolated CDH.
Usui
Noriaki
N
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan. usui@pedsurg.med.osaka-u.ac.jp
Kitano
Yoshihiro
Y
Okuyama
Hiroomi
H
Saito
Mari
M
Morikawa
Nobuyuki
N
Takayasu
Hajime
H
Nakamura
Tomoo
T
Hayashi
Satoshi
S
Kawataki
Motoyoshi
M
Ishikawa
Hiroshi
H
Nose
Keisuke
K
Inamura
Noboru
N
Masumoto
Kouji
K
Sago
Haruhiko
H
D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging; D005325:Fetal Organ Maturity; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology*; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013909:Thorax / Q000000981:diagnostic imaging / Q000196:embryology*; D016216:Ultrasonography, Prenatal / Q000379:methods