title: Correlation of Observed-to-Expected MRI Fetal Lung Volume and Ultrasound Lung-to-Head Ratio at Different Gestational Times in Fetuses With Congenital Diaphragmatic Hernia.
abstract: OBJECTIVE
  The purpose of this study is to compare the observed-to-expected MRI fetal lung volume and the observed-to-expected ultrasound lung-to-head ratio intraindividually for prediction of survival, the need for extracorporeal membrane oxygenation (ECMO) therapy, and the development of chronic lung disease (CLD) at different times of gestation (< 28, 28-32, and > 32 weeks) in fetuses with congenital diaphragmatic hernia (CDH), and to analyze the intraindividual correlation of observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio.
  
  
  METHODS
  Two hundred one fetuses were included in our study. Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio were calculated for 270 MRI and ultrasound examinations performed within 72 hours of each other. The prognostic accuracy of observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio was assessed by performing ROC analysis. Correlation was determined using linear regression analysis.
  
  
  RESULTS
  The results revealed statistically significant differences between the observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio for the prediction of survival, the need for ECMO therapy, and the development of CLD in fetuses with left-sided CDH (p ≤ 0.0444), with the highest prognostic accuracy for survival (AUC = 0.863). Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio correlated statistically significantly (p < 0.0001) for left-sided CDH with correlation coefficients (r) of 0.71, 0.71, and 0.56 for early, intermediate, and late times of gestation, respectively. The correlation was not statistically significant at any time for right-sided CDH (p ≥ 0.3947; r ≤ 0.26).
  
  
  CONCLUSIONS
  Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio are valuable prognostic parameters for prenatal prediction of survival, the need for ECMO therapy, and the development of CLD in fetuses with left-sided CDH at all times of gestation. Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio correlate statistically significantly for left-sided CDH, and the correlation is best before 32 weeks' gestation, but they do not correlate statistically significantly for right-sided CDH.
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany.
authors.forename: Katrin E
authors.initials: KE
authors.lastname: Kastenholz
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Weis
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Hagelstein
authors.affiliation: 2 Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.affiliation: 3 Department of Obstetrics and Gynaecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.|4 Present address: Department of Obstetrics and Gynaecology, Center for Perinatal Medicine, University Medical Center Erlangen, Erlangen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
authors.affiliation: 5 Department of Neonatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaible
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany.
authors.forename: K Wolfgang
authors.initials: KW
authors.lastname: Neff
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008168:Lung / Q000196:embryology*; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D015996:Survival Rate; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: MRI; congenital diaphragmatic hernia; fetal lung volume; lung-to-head ratio; ultrasound