MR Relative Fetal Lung Volume in Congenital Diaphragmatic Hernia: Survival and Need for Extracorporeal Membrane Oxygenation

Abstract

The various relative FLVs and the absolute FLV measured at MR planimetry are each highly valuable in predicting survival in fetuses with CDH. For predicting whether neonatal ECMO therapy is required, the accuracy of the absolute FLV (AUC, 0.68) and that of the relative FLVs (AUC, 0.653-0.739) was acceptable.

Right Congenital Diaphragmatic Hernias: Is There a Correlation between Prenatal Lung Volume and Postnatal Survival, as in Isolated Left Diaphragmatic Hernias?

“…Inclusion criteria were: (1) patients with available prenatal US and/or MR, (2) patients managed expectantly prenatally. Exclusion criteria: (1) technically limited US or MR, (2) no prenatal workup at our hospital, (3) no postnatal follow-up, (4) additional lung lesions, (5) additional lesions/findings that affect normal pulmonary development, (6) incorrect diagnosis.…”

“…CDH has a prevalence of about 1-4 per 10,000 births, of which approximately 85% are left-sided (L-CDH), 13% are right-sided (R-CDH), and 2% are bilateral. Prognostic indicators of postnatal survival in the fetus with L-CDH have been extensively evaluated in the past, including the presence of herniated intrathoracic liver and the degree of lung hypoplasia as reflected by the measured fetal lung volumes [1][2][3][4][5] . Because of its relative infrequency, R-CDH has rarely been studied.…”

Prenatal Anatomical Imaging in Fetuses with Congenital Diaphragmatic Hernia

“…MRI lung volumetry may become the method of choice when others validate the findings from a recent European study, which demonstrated the predictive value of lung size in terms of survival, in analogy to what was demonstrated for US [34] . It has also been used to predict the need for extracorporeal membrane oxygenation [35,36] . Recently, the group of Prayer demonstrated that lung signal intensity ratios did not have any additional value in predicting prognosis [37] .…”

Predictors of Mortality and Morbidity in Infants with CDH

“…Some studies report a significantly higher likelihood of death if the O/E TFLV were < 30-35% (Büsing et al, 2008;Cannie et al, 2008;Bonfils et al, 2006). This measurement is considered, to date, as the most accurate prognostic factor for survival of both left-sided and right-sided CDH (Gerards et al, 2008).…”