title: Prediction of mortality and the need for neonatal extracorporeal membrane oxygenation therapy by 3-dimensional sonography and magnetic resonance imaging in fetuses with congenital diaphragmatic hernias.
abstract: OBJECTIVE
  To compare different rotation angles for assessment of fetal lung volume by 3-dimensional (3D) sonography with magnetic resonance imaging (MRI) regarding prediction of mortality and the need for neonatal extracorporeal membrane oxygenation (ECMO) therapy in fetuses with congenital diaphragmatic hernias.
  
  
  METHODS
  One hundred patients with fetal congenital diaphragmatic hernias between 22 and 39 weeks' gestation were examined by 3D sonography and MRI. Sonographic contralateral fetal lung volumes were assessed by the rotational technique (virtual organ computer-aided analysis) at 3 different rotation angles: 6°, 15°, and 30°. The MRI fetal lung volumes were calculated based on multiplanar T2-weighted MRI. To eliminate the influence of gestational age, the observed to expected contralateral fetal lung volume on sonography and the observed to expected fetal lung volume on MRI were calculated. Receiver operating characteristic (ROC) curves were calculated for the statistical prediction of survival and need for ECMO therapy by the observed to expected contralateral fetal lung volume (sonography) and observed to expected fetal lung volume (MRI).
  
  
  RESULTS
  One hundred cases were assessed for survival and 89 for ECMO necessity (11 neonates were not eligible for ECMO). For prediction of postpartum survival and ECMO necessity, the areas under the ROC curves (AUCs) showed very similar results for MRI and 3D sonography: observed to expected fetal lung volume by MRI, 0.819 (95% confidence interval, 0.730-0.909) and 0.835 (0.748-0.922), respectively; 6° sonography, 0.765 (0.647-0.883) and 0.820 (0.734-0.905); 15° sonography, 0.784 (0.672-0.896) and 0.811 (0.719-0.903); and 30° sonography, 0.732 (0.609-0.855) and 0.772 (0.671-0.872). Comparisons between the AUCs revealed no statistical differences.
  
  
  CONCLUSIONS
  We have shown the good prognostic value of 3D sonography in fetuses with congenital diaphragmatic hernias compared with MRI, particularly when using small rotation angles. Therefore, it can be an appropriate diagnostic tool when counseling patients for congenital diaphragmatic hernias.
authors.affiliation: Department of Obstetrics and Gynecology, Mannheim University Medical Center, Mannheim, Germany. sven.kehl@gmail.com
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
authors.forename: Leonie
authors.initials: L
authors.lastname: Becker
authors.forename: Sven
authors.initials: S
authors.lastname: Eckert
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaible
authors.forename: K Wolfgang
authors.initials: KW
authors.lastname: Neff
authors.forename: Jörn
authors.initials: J
authors.lastname: Siemer
authors.forename: Marc
authors.initials: M
authors.lastname: Sütterlin
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data*; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D064847:Multimodal Imaging / Q000706:statistics & numerical data; D020380:Needs Assessment; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*
keywords: 3-dimensional sonography; congenital diaphragmatic hernia; extracorporeal membrane oxygenation; magnetic resonance imaging; mortality; prediction