This illustrative review depicts the evolving role of magnetic resonance imaging (MRI) in the diagnosis and prognostication of anomalies of the fetal body (here including head and neck, thorax, abdomen and spine). A review of the current literature describing the state-of-theart in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable 3D video models that demonstrate the potential of post-acquisition reconstruction protocols.Within, we will discuss benefits and limitations of fetal MRI across the breadth of conditions included: from anomaly detection, classification and prognostication as well as defining the role of imaging in the decision to proceed to prenatal intervention. Reference will also be made to the current capabilities of ultrasound and we will explore potential ways in which the two may perform complimentary roles in the future of prenatal imaging.

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Within a group of young people with complex congenital heart disease, those with HLHS are likely to have worse physical, psychological and educational outcomes.

Introduction The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13%. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers. Materials and Methods All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics. Results Across the four centers, 117/1,350, 8.7% were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5%) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8%) compared with those in the European Union (43/935, 4.6%) (p < 0.00001), and this was independent of individual center and year of birth. Conclusion Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.

Objectives To calculate 3D‐segmented total lung volume (TLV) in fetuses with thoracic anomalies using deformable slice‐to‐volume registration (DSVR) with comparison to 2D‐manual segmentation. To establish a normogram of TLV calculated by DSVR in healthy control fetuses. Methods A pilot study at a single regional fetal medicine referral centre included 16 magnetic resonance imaging (MRI) datasets of fetuses (22–32 weeks gestational age). Diagnosis was CDH (n = 6), CPAM (n = 2), and healthy controls (n = 8). Deformable slice‐to‐volume registration was used for reconstruction of 3D isotropic (0.85 mm) volumes of the fetal body followed by semi‐automated lung segmentation. 3D TLV were compared to traditional 2D‐based volumetry. Abnormal cases referenced to a normogram produced from 100 normal fetuses whose TLV was calculated by DSVR only. Results Deformable slice‐to‐volume registration‐derived TLV values have high correlation with the 2D‐based measurements but with a consistently lower volume; bias −1.44 cm3 [95% limits: −2.6 to −0.3] with improved resolution to exclude hilar structures even in cases of motion corruption or very low lung volumes. Conclusions Deformable slice‐to‐volume registration for fetal lung MRI aids analysis of motion corrupted scans and does not suffer from the interpolation error inherent to 2D‐segmentation. It increases information content of acquired data in terms of visualising organs in 3D space and quantification of volumes, which may improve counselling and surgical planning.

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Interleukin (IL)-8 (CXCL8), a chemokine involved in neutrophil recruitment, has been implicated in ductular reaction and liver fibrogenesis. We studied liver and serum IL-8 expression in a large biliary atresia (BA) cohort and explored its prognostic and pathophysiological potential. IL-8 expression was assessed in liver utilizing quantitative polymerase chain reaction (qPCR), immunohistochemistry and in situ hybridization and in serum using an enzyme-linked immunosorbent assay, among 115 BA patients, 10 disease controls and 68 normal controls. Results were correlated to portoenterostomy (PE) outcomes, biochemical and histological liver injury, transcriptional markers of fibrosis and cholangiocytes, and expression of other related cytokines. IL-8 was markedly overexpressed in liver and serum of BA patients at PE (n = 88) and in serum samples obtained during postoperative follow-up (n = 40). IL-8 expression in the liver was predominantly in cholangiocytes within areas of ductular reaction. Liver IL-8 mRNA expression correlated positively with its serum concentration, bile ductular proliferation, Metavir fibrosis stage, and transcriptional markers of activated myofibroblasts (ACTA2) and cholangiocytes (KRT19). Taken together, IL-8 may mediate liver injury in BA by promoting ductular reaction and associated liver fibrogenesis. Prognostic value of serum IL-8 to predict native liver survival was limited and confined to the postoperative period after PE.

Objective: This review and pooled analysis sought to demonstrate objective evidence of improved graft function in lung transplant patients undergoing anti-reflux surgery (ARS). Summary Background Data: ARS has been adopted in select patients with lung transplant for the past two decades across many centers. Outcomes have been reported sporadically as retrospective series and no pooled analysis has been performed. Methods:In accordance with MOOSE guidelines, a search of PubMed Central, Medline, Google Scholar and Cochrane Library databases was performed. Papers documenting spirometry data pre-and post-ARS were reviewed and a random-effects model meta-analysis was performed on FEV1 values and the rate of change of FEV1.Results: 6 papers were included in the meta-analysis. Regarding FEV1 before and after ARS, we observed a small increase in FEV1 values in studies reporting raw values in L/1sec(2.02+/-0.89 vs. 2.14+/-0.77, n=154) and % of predicted (77.1+/-22.1 vs. 81.2+/-26.95, n=45), with a 'small' pooled Cohen's d effect size of 0.159(p=0.114). When considering the rate of change of FEV1 (ml/day) we observed a significant difference in pre-ARS compared to post-ARS (-2.12 +/-2.76 ml/day vs. +0.05+/-1.19, n=103). There was a pooled effect size of 1.702(p=0.013), a "large" effect of ARS on the rate of change of FEV1 values. Conclusions:This meta-analysis of retrospective observational studies demonstrates that ARS might benefit patients with declining FEV1 examining the rate of change of FEV1 in the pre-and post-operative periods.