Use of magnetic resonance imaging in prenatal prognosis of the fetus with isolated left congenital diaphragmatic hernia.
OBJECTIVE
To investigate the prognostic value of magnetic resonance-calculated fetal lung volumes (FLV) in fetuses with isolated left congenital diaphragmatic hernia (L-CDH) who receive standardized prenatal and postnatal care at a single institution.


METHODS
A retrospective review was undertaken to identify fetuses with isolated L-CDH between 2001 and 2010.


RESULTS
Eighty-five cases of isolated L-CDH were identified. The overall survival was 65% (55/85). Survival was 45% if there was 'liver up' (23/51) and 94% if there was 'liver down' (32/34). Univariate statistical analysis showed that 'liver up' (p=0.001), lung-to-head ratio (LHR) at diagnosis (p=0.009), observed/expected (O/E) LHR (p=0.01), total FLV (p=0.03), right LV (p=0.04), magnetic resonance imaging (MRI) observed versus expected (O/E) FLV (p=0.002), intrathoracic versus intraabdominal stomach (p=0.002), percentage of herniated liver (p=0.004), and postnatal extracorporeal membrane oxygenation use (p=0.001) are predictive of postnatal survival. Multivariate analysis of only prenatal factors showed that the most important determinants of postnatal outcome are percentage of herniated liver, presence of liver up, and MRI O/E FLV.


CONCLUSIONS
Herniated intrathoracic liver expressed as 'liver up' or as percent herniated liver and MRI measurement of FLV expressed as a O/E ratio are strong prenatal indicators of postnatal survival.
Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, 19103, USA. victoria@email.chop.edu
Teresa
T
Victoria
Michael W
MW
Bebbington
Enrico
E
Danzer
Alan W
AW
Flake
Mark P
MP
Johnson
David
D
Dinan
N Scott
NS
Adzick
Holly L
HL
Hedrick
D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000473:pathology*; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000473:pathology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008099:Liver / Q000473:pathology*; D008168:Lung / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D009929:Organ Size; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*