title: Fetal MRI lung volumes are predictive of perinatal outcomes in fetuses with congenital lung masses.
abstract: OBJECTIVE
  The purpose of this study was to evaluate fetal magnetic resonance imaging (MRI) as a modality for predicting perinatal outcomes and lung-related morbidity in fetuses with congenital lung masses (CLM).
  
  
  METHODS
  The records of all patients treated for CLM from 2002 to 2012 were reviewed retrospectively. Fetal MRI-derived lung mass volume ratio (LMVR), observed/expected normal fetal lung volume (O/E-NFLV), and lesion-to-lung volume ratio (LLV) were calculated. Multivariate regression and receiver operating characteristic analyses were applied to determine the predictive accuracy of prenatal imaging.
  
  
  RESULTS
  Of 128 fetuses with CLM, 93% (n=118) survived. MRI data were available for 113 fetuses. In early gestation (<26weeks), MRI measurements of LMVR and LLV correlated with risk of fetal hydrops, mortality, and/or need for fetal intervention. In later gestation (>26weeks), LMVR, LLV, and O/E-NFLV correlated with neonatal respiratory distress, intubation, NICU admission and need for neonatal surgery. On multivariate regression, LMVR was the strongest predictor for development of fetal hydrops (OR: 6.97, 1.58-30.84; p=0.01) and neonatal respiratory distress (OR: 12.38, 3.52-43.61; p≤0.001). An LMVR >2.0 predicted worse perinatal outcome with 83% sensitivity and 99% specificity (AUC=0.94; p<0.001).
  
  
  CONCLUSIONS
  Fetal MRI volumetric measurements of lung masses and residual normal lung are predictive of perinatal outcomes in fetuses with CLM. These data may assist in perinatal risk stratification, counseling, and resource utilization.
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Fariha
authors.initials: F
authors.lastname: Sheikh
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Cassady
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Mehollin-Ray
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Cecilia G
authors.initials: CG
authors.lastname: Ethun
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kim
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: dcass@bcm.edu.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
mesh_terms: D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000196:embryology*; D008171:Lung Diseases / Q000151:congenital / Q000175:diagnosis* / Q000196:embryology; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013990:Tidal Volume
keywords: CCAM; CPAM; Congenital lung malformation; Fetal MRI; Fetal lung volumes; Perinatal outcomes; Risk stratification