title: Fetal lung volume in congenital diaphragmatic hernia: association of prenatal MR imaging findings with postnatal chronic lung disease.
abstract: OBJECTIVE
  To assess whether chronic lung disease (CLD) in surviving infants with congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia on the basis of the results of antenatal observed-to-expected fetal lung volume (FLV) ratio measurement at magnetic resonance (MR) imaging.
  
  
  METHODS
  The study received approval from the institutional review board, with waiver of informed consent for this retrospective review from patients who had previously given informed consent for prospective studies. The ratio of observed to expected FLV at MR imaging was calculated in 172 fetuses with CDH. At postpartum day 28, the need for supplemental oxygen implicated the diagnosis of CLD. At day 56, patients with CLD were assigned to one of three groups-those with mild, moderate, or severe CLD-according to their demand for oxygen. Logistic regression analysis was used to assess the prognostic value of the individual observed-to-expected FLV ratio for association with postnatal development of CLD.
  
  
  RESULTS
  Children with CLD were found to have significantly smaller observed-to-expected FLV ratios at MR imaging than infants without CLD (P < .001). Grading of CLD revealed significant differences in observed-to-expected FLV ratio between patients with mild CLD and those with moderate (P = .012) or severe (P = .007) CLD. For an observed-to-expected FLV ratio of 5%, 99% of patients with CDH developed CLD, compared with less than 5% of fetuses with an observed-to-expected FLV ratio of 50%. Perinatally, development and grade of CLD were further influenced by the need for extracorporeal membrane oxygenation (ECMO) (P < .001) and gestational age at delivery (P = .009).
  
  
  CONCLUSIONS
  Manifestation of CLD in surviving infants with CDH is associated with the prenatally determined observed-to-expected FLV ratio. Early neonatal therapeutic decisions can additionally be based on this ratio. Perinatally, ECMO requirement and gestational age at delivery are useful in further improving the estimated probability of CLD.
authors.affiliation: Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. angelika.debus@umm.de
authors.forename: Angelika
authors.initials: A
authors.lastname: Debus
authors.forename: Claudia
authors.initials: C
authors.lastname: Hagelstein
authors.forename: A Kristina
authors.initials: AK
authors.lastname: Kilian
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schönberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaible
authors.forename: K Wolfgang
authors.initials: KW
authors.lastname: Neff
authors.forename: Karen A
authors.initials: KA
authors.lastname: Büsing
mesh_terms: D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000453:epidemiology* / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D055370:Lung Injury / Q000453:epidemiology* / Q000473:pathology*; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D011296:Prenatal Diagnosis / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity