title: Correlation of observed-to-expected total fetal lung volume with intrathoracic organ herniation on magnetic resonance imaging in fetuses with isolated left-sided congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To assess using fetal magnetic resonance imaging (MRI) the relationship between the position of the stomach as well as the volume of herniation of organs into the thorax, and the observed-to-expected total fetal lung volume (o/e-TFLV), as a measure of pulmonary hypoplasia, in fetuses with isolated left-sided congenital diaphragmatic hernia (LCDH).
  
  
  METHODS
  This was a single-center retrospective study using archived MR images from fetuses > 20 weeks' gestation evaluated for isolated LCDH over an 11-year period between July 2002 and September 2013. We retrieved data on the gestational age at MRI, o/e-TFLV and liver position. Images were also reviewed by a single operator to determine retrospectively the position of the stomach as well as the proportion of the total thorax volume occupied by the herniated fetal liver, stomach and other viscera. Following confirmation of reproducibility, we assessed the correlation of intrathoracic organ volumes and stomach position with o/e-TFLV.
  
  
  RESULTS
  The study included 205 fetuses which underwent a total of 259 MR examinations. The reproducibility of organ volume measurements was excellent (intraclass correlation coefficient range, 0.928-0.997). The average time spent to obtain intrathoracic organ volumes ranged from 2.28 to 5.13 min. Of all herniated organ-to-thoracic volume ratios, the liver-to-thoracic volume ratio had the strongest correlation with o/e-TFLV (ρ = -0.429, P<0.0001). Stomach volume did not correlate, although, when categorized by the position and extent of stomach herniation, there was an inverse relationship to o/e-TFLV. No intrathoracic organ-to-thoracic volume ratio was related to gestational age.
  
  
  CONCLUSIONS
  We observed in fetuses with isolated LCDH an inverse relationship between lung volume and the amount of liver herniated as well as the position of the stomach in the chest.
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.|Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Nawapun
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Eastwood
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.|Division of Medical Imaging, Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Sandaite
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.|Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: DeKoninck
authors.affiliation: Division of Medical Imaging, Department of Radiology, University Hospitals Leuven, Leuven, Belgium.|Department of Radiology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Claus
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.|Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Richter
authors.affiliation: Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Rayyan
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.|Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis; D005260:Female; D005315:Fetal Diseases / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000473:pathology; D008107:Liver Diseases / Q000151:congenital* / Q000175:diagnosis; D008168:Lung / Q000002:abnormalities* / Q000196:embryology; D008171:Lung Diseases / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology
keywords: congenital diaphragmatic hernia; liver volume; magnetic resonance imaging; pulmonary hypoplasia; stomach position; stomach volume