title: Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To determine associations between fetal lung and liver herniation volumes measured by magnetic resonance imaging (MRI) and mortality/need for extracorporeal membrane oxygenation (ECMO) in cases of isolated congenital diaphragmatic hernia (CDH). A secondary objective was to compare prenatal MRI parameters with two-dimensional ultrasound lung measurements.
  
  
  METHODS
  A retrospective review of medical records of all fetuses with isolated CDH evaluated between January 2004 and July 2012 was performed. The following MRI parameters were measured at 20-32 weeks: observed/expected total fetal lung volume (o/e-TLV), predicted pulmonary volume (PPV), percentage of liver herniated into the fetal thorax (%LH) and the liver/thoracic volume ratio (LiTR). These were compared with the ultrasound-determined lung-to-head ratio (LHR) and the observed/expected LHR (o/e-LHR) in the same cohort. The predictive value of MRI and ultrasound parameters for mortality and the need for ECMO was evaluated by univariate, multivariate and factor analysis and by receiver-operating characteristics curves.
  
  
  RESULTS
  Eighty fetuses with isolated CDH were evaluated. Overall mortality was 18/80 (22.5%). Two newborns died a few hours after birth. ECMO was performed in 29/78 (37.2%) newborns, with a survival rate of 48.3% (14/29). The side of the diaphragmatic defect was not associated with mortality (P = 0.99) or the need for ECMO (P = 0.48). Good correlation was observed among o/e-TLV, PPV, LHR and o/e-LHR as well as between %LH and LiTR (r = 0.89; P < 0.01); however, fetal lung measurements and measures of liver herniation were not correlated (all P > 0.05). All parameters were statistically associated with mortality or the need for ECMO. The best combination of measurements to predict mortality was o/e-TLV and %LH, with 83% accuracy.
  
  
  CONCLUSIONS
  Mortality and the need for ECMO in neonates with isolated CDH can be best predicted using a combination of MRI o/e-TLV and %LH.
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ruano
authors.forename: D A
authors.initials: DA
authors.lastname: Lazar
authors.forename: D L
authors.initials: DL
authors.lastname: Cass
authors.forename: I J
authors.initials: IJ
authors.lastname: Zamora
authors.forename: T C
authors.initials: TC
authors.lastname: Lee
authors.forename: C I
authors.initials: CI
authors.lastname: Cassady
authors.forename: A
authors.initials: A
authors.lastname: Mehollin-Ray
authors.forename: S
authors.initials: S
authors.lastname: Welty
authors.forename: C J
authors.initials: CJ
authors.lastname: Fernandes
authors.forename: S
authors.initials: S
authors.lastname: Haeri
authors.forename: M A
authors.initials: MA
authors.lastname: Belfort
authors.forename: O O
authors.initials: OO
authors.lastname: Olutoye
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005315:Fetal Diseases / Q000473:pathology*; D006257:Head / Q000196:embryology; D065630:Hernias, Diaphragmatic, Congenital / Q000473:pathology*; D006801:Humans; D008107:Liver Diseases / Q000196:embryology / Q000473:pathology*; D008168:Lung / Q000196:embryology*; D008176:Lung Volume Measurements / Q000379:methods; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: congenital diaphragmatic hernia; diaphragm hernia outcomes; fetal lung volumes, fetal ultrasound; liver herniation; lung-to-head ratio; magnetic resonance imaging; prenatal diagnosis; prenatal predictors