title: Periodic MRI lung volume assessment in fetuses with congenital diaphragmatic hernia: prediction of survival, need for ECMO, and development of chronic lung disease.
abstract: OBJECTIVE
  The purpose of the study was to investigate the ability to predict survival, need for extracorporeal membrane oxygenation (ECMO), and incidence of chronic lung disease in patients with congenital diaphragmatic hernia in the context of a classification into three different times of gestation (< 28, 28-32, and > 32 weeks) by assessing the ratio between observed and expected MRI fetal lung volume.
  
  
  METHODS
  The data analysis included 226 fetuses with congenital diaphragmatic hernia. MRI was performed at different times of gestation with a T2-weighted HASTE sequence. Receiver operating characteristic curve analysis was performed to investigate the prognostic value of assessment of the ratio between observed and expected MRI fetal lung volumes at different stages of fetal growth.
  
  
  RESULTS
  For all reviewed times of gestation, the ratio between observed and expected MRI fetal lung volumes had almost equivalent statistically significant differences for neonatal survival (p ≤ 0.0029), need for ECMO therapy (p ≤ 0.0195), and development of chronic lung disease (p ≤ 0.0064). Results with high prognostic accuracy for early and for medium and late times in gestation also were obtained. Receiver operating characteristic analysis showed the highest area under the curve (≥ 0.819) for neonatal survival.
  
  
  CONCLUSIONS
  In patients with congenital diaphragmatic hernia, the relation between observed and expected MRI fetal lung volume is a valuable prognostic parameter for predicting neonatal mortality, morbidity represented by the development of chronic lung disease, and the need for ECMO therapy in early gestation (< 28 weeks) as well as later gestation with no statistically significant differences.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. anna.walleyo@umm.de
authors.forename: Anna
authors.initials: A
authors.lastname: Walleyo
authors.forename: Angelika
authors.initials: A
authors.lastname: Debus
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
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: Karen A
authors.initials: KA
authors.lastname: Büsing
authors.forename: K Wolfgang
authors.initials: KW
authors.lastname: Neff
mesh_terms: D000328:Adult; D019540:Area Under Curve; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008171:Lung Diseases / Q000175:diagnosis*; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate