title: Stomach position versus liver-to-thoracic volume ratio in left-sided congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To describe a new grading method for stomach position (SP) in fetuses with left-sided congenital diaphragmatic hernia (L-CDH) using ultrasound and to correlate SP to liver position and to liver-to-thoracic cavity volume ratio (LiTR) using magnetic resonance imaging.
  
  
  METHODS
  SP were graded at the level of the 4-chamber view as following: grade 1-to-4 for stomach not visualised, visualised anteriorly at the apex of the heart, stomach showing abdominal structures anteriorly and stomach with its larger part posterior to the level of the atrial-ventricular heart valves, respectively. The LiTR was calculated and correlated to SP using the Mann-Whitney U test.
  
  
  RESULTS
  Seventy-four fetuses were included. Median LiTR for grade 1 SP was 0% and was not different from median LiTR for grade 2 SP (0%, p=NS). Median LiTR for grade 3 SP was 14.9% and was significantly higher than for grade 2 SP (p<0.001). Similarly, median LiTR for grade 4 SP was 20.7% and was significantly higher than for grade 3 SP (p<0.05). When SP was grade 1 or 2, liver was intra-abdominal in 21 (84%) out of 25 fetuses while it was always intrathoracic for SP 3 or 4.
  
  
  CONCLUSIONS
  In L-CDH, SP as described represents a simple indirect measurement of intrathoracic position and quantification of liver.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Medicine, Centre Maladies Rares, Hernie de Coupole Diaphragmatique, Hôpital Antoine Béclère, APHP, Université Paris Sud , Paris , France .
authors.forename: Anne-Gaël
authors.initials: AG
authors.lastname: Cordier
authors.forename: Mieke M
authors.initials: MM
authors.lastname: Cannie
authors.forename: Lucie
authors.initials: L
authors.lastname: Guilbaud
authors.forename: Jocelyne
authors.initials: J
authors.lastname: De Laveaucoupet
authors.forename: Jéléna
authors.initials: J
authors.lastname: Martinovic
authors.forename: Dorota
authors.initials: D
authors.lastname: Nowakowska
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Milejska-Lewandowska
authors.forename: Carlota
authors.initials: C
authors.lastname: Rodó
authors.forename: Benjamin
authors.initials: B
authors.lastname: Viaris de Lesegno
authors.forename: Carmela
authors.initials: C
authors.lastname: Votino
authors.forename: Marie-Victoire
authors.initials: MV
authors.lastname: Senat
authors.forename: Jacques C
authors.initials: JC
authors.lastname: Jani
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
mesh_terms: D005260:Female; D005333:Fetus / Q000473:pathology; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology*; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009929:Organ Size; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology*; D035423:Thoracic Cavity / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology*; D016216:Ultrasonography, Prenatal
keywords: Diaphragmatic hernia; magnetic resonance imaging; quantification of liver; stomach grading; stomach position