title: Late gestation fetal magnetic resonance imaging-derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) has been used as an imaging modality to assess pulmonary hypoplasia in congenital diaphragmatic hernias (CDHs). The objective of this study was to determine if there is a correlation between late gestational fetal MRI-derived total lung volumes (TLVs) and CDH outcomes.
  
  
  METHODS
  From 2006 to 2009, 44 patients met criteria of an isolated CDH with a late gestational MRI evaluation. The prenatal TLV (in milliliters) was obtained between 32 and 34 weeks gestation. The measured study outcomes included survival, need for extracorporeal membrane oxygenation (ECMO), and length of stay.
  
  
  RESULTS
  There were 39 left and 5 right CDH patients. The average TLV was significantly lower for nonsurvivors (P = .01), and there was a significant association between lower TLV and the need for ECMO (P = .0001). When stratified by TLV, patients with a TLV of greater than 40 mL had a 90% survival vs 35% survival for a TLV of less than 20 mL. Furthermore, patients with a TLV greater than 40 mL had a lower rate of ECMO use (10%) than patients with a TLV of less than 20 mL (86%). Shorter length of stay was found to correlate with increasing TLV (P = .022).
  
  
  CONCLUSIONS
  Late gestation fetal MRI-derived TLV significantly correlates with postnatal survival and need for ECMO. Fetal MRI may be useful for the evaluation of patients who present late in gestation with a CDH.
authors.affiliation: The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Foong Y
authors.initials: FY
authors.lastname: Lim
authors.forename: Sundeep G
authors.initials: SG
authors.lastname: Keswani
authors.forename: Jason S
authors.initials: JS
authors.lastname: Frischer
authors.forename: Beth
authors.initials: B
authors.lastname: Haberman
authors.forename: Paul S
authors.initials: PS
authors.lastname: Kingma
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Jaekle
authors.forename: Gina
authors.initials: G
authors.lastname: Sharp
authors.forename: Beth
authors.initials: B
authors.lastname: Kline-Fath
authors.forename: Eva I
authors.initials: EI
authors.lastname: Rubio
authors.forename: Maria
authors.initials: M
authors.lastname: Calvo
authors.forename: Carolina
authors.initials: C
authors.lastname: Guimaraes
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Crombleholme
mesh_terms: D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011181:Postnatal Care / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013990:Tidal Volume; D016896:Treatment Outcome