title: In vivo evidence by magnetic resonance volumetry of a gestational age dependent response to tracheal occlusion for congenital diaphragmatic hernia.
abstract: OBJECTIVE
  We aimed to assess in vivo changes in lung and liver volumes in fetuses with isolated congenital diaphragmatic hernia, either expectantly managed or treated in utero.
  
  
  METHODS
  This is a secondary analysis of prospectively collected data at two fetal therapy centers. We used archived magnetic resonance images of fetuses taken ≥7 days apart, creating paired observations in 20 expectantly managed cases, 41 with a second magnetic resonance prior to balloon reversal and 64 after balloon removal. We measured observed to expected total fetal lung volume (O/E TFLV) and liver-to-thoracic volume ratio. We calculated changes in volume as compared with the initial measurement and its rate as a function of gestational age (GA) at occlusion.
  
  
  RESULTS
  The liver-to-thoracic volume ratio did not change in either group. In expectantly managed fetuses, O/E TFLV did not increase with gestation. In fetuses undergoing tracheal occlusion, the measured increase in volume was 2.6 times larger with balloon in place as compared with that after its removal. GA at tracheal occlusion was an independent predictor of the O/E TFLV. The net rate seems to initially increase and plateau at a maximum of 1.5% per week by 35 to 45 days after occlusion.
  
  
  CONCLUSIONS
  Tracheal occlusion induces a net increase in volume, its magnitude essentially dependent on the GA at occlusion.
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: Katika
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: Mary Patrice
authors.initials: MP
authors.lastname: Eastwood
authors.affiliation: Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clinic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Daysi
authors.initials: D
authors.lastname: Diaz-Cobos
authors.affiliation: Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Julio
authors.identifier: http://orcid.org/0000-0001-6260-2814
authors.initials: J
authors.lastname: Jimenez
authors.affiliation: Division of Medical Imaging, Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Michael
authors.initials: M
authors.lastname: Aertsen
authors.affiliation: Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clinic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Gomez
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: Filip
authors.initials: F
authors.lastname: Claus
authors.affiliation: Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clinic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
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: Jan
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D046128:Fetal Therapies / Q000379:methods; D005333:Fetus / Q000473:pathology*; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000196:embryology / Q000473:pathology*; D008168:Lung / Q000196:embryology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D009929:Organ Size; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D014132:Trachea; D057832:Watchful Waiting