Ipsilateral Lung Volumes Assessed by Three-Dimensional Ultrasonography in Fetuses with Isolated Congenital Diaphragmatic Hernia

Abstract

Objective: To evaluate the precision of three-dimensional ultrasonography (3DUS) in estimating the ipsilateral lung volume and the potential of this measurement to predict neonatal death in congenital diaphragmatic hernia (CDH). Methods: Between January 2002 and December 2004, the ipsilateral lung volumes were assessed by 3DUS using the technique of rotation of the multiplan imaging in 39 fetuses with CDH. The observed/expected ipsilateral lung volume ratios (o/e-IpsiFLVR) were compared to the lung/head ratios (LHR) and to the observed/expected total fetal lung volume ratios (o/e-TotFLVR) as well as to postnatal death. Results: Ipsilateral lung volumes (median 0.12, range 0.01–0.66) were more reduced than the total lung volumes (median 0.52, range 0.11–0.95, p < 0.001) in CDH. The bias and precision of 3DUS in estimating ipsilateral lung volumes were –0.61 and 0.99 cm³, respectively, with absolute limits of agreement from –2.56 to +1.33 cm³. The o/e-IpsiFLVR was lower in neonatal death cases (median 0.09, range 0.01–0.46) than in survivals (median 0.18, range 0.01–0.66), but this difference was not statistically significance (p > 0.05). The sensitivity, specificity, (positive and negative) predictive values and accuracy of o/e-IpsiFLVR in predicting neonatal death was 52.6% (10/19), 83.3% (10/12), 83.3% (10/12), 52.6% (10/19) and 64.5% (20/31), respectively. Conclusion: Although the ipsilateral lung volume can be measured by 3DUS, it cannot be used to predict neonatal death when considering it alone. However, it is important to measure it to calculate the total fetal lung volumes as the o/e-TotFLVR has the best efficacy in predicting neonatal death in isolated CDH.

Differential patterns of prenatal ipsilateral and contralateral lung growth in cases of isolated left-sided congenital diaphragmatic hernia

“…In agreement with previous studies, lung hypoplasia in CDH appears to develop in both the ipsilateral and contralateral lungs but to a greater degree on the ipsilateral side . In attempt to explain this pattern, Hagelstein et al .…”

Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters

“…A European group suggested classifying fetuses with isolated CDH into extremely severe, severe, moderate and mild forms, based on the observed/expected lung‐to‐head ratio (LHR) and the presence of herniated liver in the fetal thorax6, 7. Several fetal parameters have been proposed in order to predict neonatal outcome in isolated CDH based on lung sizes, position of the liver and pulmonary vasculature status6, 8–20. However, as yet there is no consensus as to which parameter is most accurate and useful in predicting neonatal outcome in these cases.…”

Fetal Pulmonary Response After Fetoscopic Tracheal Occlusion for Severe Isolated Congenital Diaphragmatic Hernia

“…[5][6][7][8][9][10] Fetal endoscopic tracheal occlusion has been shown to stimulate fetal lung growth in both animal models and humans with congenital diaphragmatic hernia. 11,12 Our previous studies have demonstrated that fetal endoscopic tracheal occlusion can improve neonatal survival in severe cases of congenital diaphragmatic hernia.…”