title: Prediction of lethal pulmonary hypoplasia by means fetal lung volume in skeletal dysplasias: a three-dimensional ultrasound assessment.
abstract: OBJECTIVE
  The aim of this study was to assess the capacity of three-dimensional ultrasound (3DUS) for predicting lethality in fetuses with skeletal dysplasia.
  
  
  METHODS
  Twenty-four fetuses between 20 and 32 weeks of gestation were assessed. Bilateral lung volume scans were performed three times in each fetus during one ultrasound session. The virtual organ computer-aided analysis method was used to obtain a sequence of six sections of each lung around a fixed axis, and a rotation angle of 30° was adopted. Fetal lung volume measurements were analyzed according to the reference range. After birth, lung hypoplasia was diagnosed considering clinical and radiological criteria.
  
  
  RESULTS
  Of all cases of skeletal dysplasia, 18 (75%) were lethal. Among the lethal cases, after postnatal diagnosis, four were osteogenesis imperfecta type II, three were thanatophoric dysplasia and two were campomelic dysplasia. The remaining nine cases remained without a definitive diagnosis. The accuracy of 3DUS in predicting lethality in fetuses with skeletal dysplasia was high, with a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 66.7%. The kappa index of 0.174 showed a good agreement between the possibility of lethality when the 3DUS volume measurement was altered and real lethality after birth (p < 0.001).
  
  
  CONCLUSIONS
  This study suggests that the 3DUS lung volume measurement is a good predictor of lethal pulmonary hypoplasia in fetuses with skeletal dysplasia, with high accuracy.
authors.affiliation: a Department of Obstetrics and Gynecology , Center of Fetal Medicine, Federal University of Minas Gerais (UFMG) , Belo Horizonte , MG , Brazil .
authors.forename: Carolina Amorim
authors.initials: CA
authors.lastname: Barros
authors.affiliation: a Department of Obstetrics and Gynecology , Center of Fetal Medicine, Federal University of Minas Gerais (UFMG) , Belo Horizonte , MG , Brazil .
authors.forename: Guilherme de Castro
authors.initials: Gde C
authors.lastname: Rezende
authors.affiliation: b Department of Obstetrics , Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) , São Paulo , SP , Brazil , and.
authors.forename: Edward
authors.initials: E
authors.lastname: Araujo Júnior
authors.affiliation: c Department of Obstetrics and Gynecology , Prenatal Diagnostic Center, Guastalla Civil Hospital , Reggio Emilia , Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Tonni
authors.affiliation: a Department of Obstetrics and Gynecology , Center of Fetal Medicine, Federal University of Minas Gerais (UFMG) , Belo Horizonte , MG , Brazil .
authors.forename: Alamanda Kfoury
authors.initials: AK
authors.lastname: Pereira
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008168:Lung / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D009139:Musculoskeletal Abnormalities / Q000150:complications*; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: Fetal lung volume; lethality; skeletal dysplasia; three-dimensional ultrasound; virtual organ computer-aided analysis