title: In vitro models of the fetal lung: comparison of lung volume measurements with 3-dimensional sonography and magnetic resonance imaging.
abstract: OBJECTIVE
  Three-dimensional (3D) sonography is an established volumetric method in gynecology and obstetrics. The aim of this study was to investigate the variability of 3D sonographic measurements and their accuracy in comparison with magnetic resonance imaging (MRI) for assessing fetal lung volume using in vitro lung models.
  
  
  METHODS
  Twenty-three in vitro lung models with randomly defined volumes ranging from 1 to 60 mL were made from gelatin with plastic sheaths, manually molded into the shape of fetal lungs. The models were measured using 3D sonography and MRI. The 3D sonographic volumes were calculated using the rotational technique with angles of 6° and 30°. Multiplanar T2-weighted sequences were used for the MRI measurements. The percentage error and absolute percentage error were calculated for each method, and intraobserver and interobserver variability in 3D sonographic measurements was assessed with intraclass correlation coefficients (ICCs). Agreement between calculated and real volumes using the limits of agreement method was also evaluated.
  
  
  RESULTS
  The ICCs for the rotation angles indicated very good intraobserver and interobserver variability (6°, 0.995 and 0.996; 30°, 0.997 and 0.985). No systematic errors were observed in the mean percentage errors for 3D sonographic measurements or MRI volumetry. The lowest median absolute percentage error (1.76) was obtained with MRI volumetry, significantly lower than the values for sonography (6°, 5.00; P < .001; 30°, 5.49; P < .001). There were no significant differences in absolute percentage errors between the rotation angles (P = .82) and no significant differences in limits of agreement between 3D sonography and MRI (6°, P = .76; 30°, P = .39).
  
  
  CONCLUSIONS
  Three-dimensional sonographic volumetry was almost as accurate as MRI in this in vitro model and can be regarded as a good alternative method. Further research is needed to confirm these findings in vivo and to assess the prognostic value in fetuses with lung hypoplasia (eg, congenital diaphragmatic hernias).
authors.affiliation: Department of Obstetrics and Gynecology, Mannheim University Hospital, Mannheim, Germany. sven.kehl@umm.de
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
authors.forename: Anna
authors.initials: A
authors.lastname: Zirulnik
authors.forename: Angelika
authors.initials: A
authors.lastname: Debus
authors.forename: Marc
authors.initials: M
authors.lastname: Sütterlin
authors.forename: Jörn
authors.initials: J
authors.lastname: Siemer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Neff
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D066298:In Vitro Techniques; D008168:Lung / Q000000981:diagnostic imaging* / Q000196:embryology*; D008176:Lung Volume Measurements / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008953:Models, Anatomic; D011247:Pregnancy; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal / Q000379:methods*