title: Surveillance of fetal lung lesions using the congenital pulmonary airway malformation volume ratio: natural history and outcomes.
abstract: OBJECTIVE
  The congenital pulmonary airway malformation volume ratio (CVR) is a widely used sonographic measure of relative mass size in fetuses with lung malformations. The purposes of this study were to examine serial CVR measurements to understand longitudinal growth patterns and to determine correlation with postnatal imaging.
  
  
  METHODS
  An institutional review board-approved retrospective review was performed on fetuses referred for an echogenic lung malformation between 2002 and 2014. For each fetus, the CVR was prospectively calculated using 2D ultrasound and followed with advancing gestation.
  
  
  RESULTS
  Based on 40 fetuses, the mean initial CVR was 0.51 ± 0.07 at 20.5 ± 0.3 weeks of gestation. The CVR increased after 24 weeks of gestation (p = 0.0014), peaking at a CVR of 0.96 ± 0.11 at 25.5 ± 0.05 weeks, followed by a significant decrease in the CVR to 0.43 ± 0.07 prior to term (p < 0.0001). However, approximately one third showed no appreciable increase in size. The mean CVR was significantly correlated with postnatal chest computed tomography (CT) size dimensions (p = 0.0032) and likelihood for lung resection (p = 0.0055).
  
  
  CONCLUSIONS
  Fetal lung malformations tend to follow one of two distinct growth patterns, characterized by either (1) a maximal CVR between 25 and 26 weeks of gestation or (2) minimal change in relative growth. The mean CVR correlates with postnatal CT size and operative management.
authors.affiliation: Department of Obstetrics and Gynecology, St. Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Catriona A
authors.initials: CA
authors.lastname: Macardle
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Ehrenberg-Buchner
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Smith
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.|Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Treadwell
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.|Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Kunisaki
mesh_terms: D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D008991:Monitoring, Physiologic / Q000379:methods*; D009929:Organ Size; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D015619:Respiratory System Abnormalities / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal