MRI-Based Ratio of Fetal Lung Volume to Fetal Body Volume as a New Prognostic Marker in Congenital Diaphragmatic Hernia

Weidner, Meike; Hagelstein, Claudia; Debus, A; Walleyo, A; Weiß, Christel; Schoenberg, Stefan O.; Schaible, Thomas; Büsing, Karen A.; Kehl, Sven; Neff, K. W.

doi:10.2214/ajr.13.11023

Cited by 23 publications

(20 citation statements)

References 26 publications

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“…Only once a comprehensive assessment has been made can multidisciplinary prenatal counseling by clinicians in tertiary centers be offered to inform parents about the estimated prognosis after birth. Several other additional imaging methods, such as lung volumetry, 3D ultrasound and Doppler studies of the pulmonary vascularization, have been shown in individual series to be prognostic for pulmonary hypertension, the need for extracorporeal membrane oxygenation (ECMO) and survival [8]. All of these remain research tools, however, but may ultimately improve the predictive value of prenatal testing.…”

Section: Resultsmentioning

confidence: 99%

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

et al. 2016

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In 2010, the congenital diaphragmatic hernia (CDH) EURO Consortium published a standardized neonatal treatment protocol. Five years later, the number of participating centers has been raised from 13 to 22. In this article the relevant literature is updated, and consensus has been reached between the members of the CDH EURO Consortium. Key updated recommendations are: (1) planned delivery after a gestational age of 39 weeks in a high-volume tertiary center; (2) neuromuscular blocking agents to be avoided during initial treatment in the delivery room; (3) adapt treatment to reach a preductal saturation of between 80 and 95% and postductal saturation >70%; (4) target PaCO₂ to be between 50 and 70 mm Hg; (5) conventional mechanical ventilation to be the optimal initial ventilation strategy, and (6) intravenous sildenafil to be considered in CDH patients with severe pulmonary hypertension. This article represents the current opinion of all consortium members in Europe for the optimal neonatal treatment of CDH.

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Section: Resultsmentioning

confidence: 99%

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

et al. 2016

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“…Basierend einerseits auf De Paepe et al [11], die post mortem mit dem Quotienten aus Lungen-zu Körpergewicht den Grad der Lungenhypoplasie bestimmten und andererseits durch die verlässliche Vorhersage der Lungenhypoplasie durch den Quotienten aus MR-FLV und sonografisch bestimmtem fetalem Gewicht [34], entstand die Idee zur Betrachtung des Quotienten aus FLV/FBV mittels MRT-Volumetrie. Weidner et al haben gezeigt, dass der Quotient im Hinblick auf Überleben (AUC 0,829) und ECMO-Bedarf (AUC 0,811) als hochwertiger prognostischer Parameter einzustufen und mit bereits etablierten Parametern hinsichtlich der prognostischen Wertigkeit vergleichbar ist [36].…”

Section: Hintergrundunclassified

MRT-basierter Quotient aus fetalem Lungen- und Ganzkörpervolumen als Prognosemarker für chronische Lungenerkrankung bei kongenitaler Zwerchfellhernie

et al. 2017

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Our aim was to evaluate the prognostic value of magnetic resonance imaging (MRI)-based ratio of fetal lung volume (FLV) to fetal body volume (FBV) as a marker for development of chronic lung disease (CLD) in fetuses with congenital diaphragmatic hernia (CDH). FLV and FBV were measured and the individual FLV/FBV ratio was calculated in 132 fetuses. Diagnosis of CLD was established following prespecified criteria and graded into mild/moderate/severe if present. Logistic regression analysis was used to calculate the probability of postnatal development of CLD in dependence of the FLV/FBV ratio. Receiver operating characteristic curves were analysed by calculating the area under the curve to evaluate the prognostic accuracy of this marker. 61 of 132 fetuses developed CLD (46.21%). The FLV/FBV ratio was significantly lower in fetuses with CLD (p=0.0008; AUC 0.743). Development of CLD was significantly associated with thoracic herniation of liver parenchyma (p<0.0001), requirement of extracorporal membrane oxygenation (ECMO) (p<0.0001) and gestational age at delivery (p=0.0052). The MRI-based ratio of FLV to FBV is a highly valuable prenatal parameter for development of CLD. The ratio is helpful for early therapeutic decisions by estimating the probability to develop CLD. Perinatally, gestational age at delivery and ECMO requirement are useful additional parameters to further improve prediction of CLD.

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“…Several teams have reported their experience with prediction of outcome using either ultrasound or magnetic resonance imaging, based on lung measurement and liver or stomach position. However, there are inadequate numbers in these studies to truly demonstrate whether these are independent predictors of outcome . Although tracheal occlusion for CDH may reduce mortality (and apparently also early neonatal morbidity), it should be still considered investigational.…”

Section: Advances In Fetal Surgerymentioning

confidence: 99%

In case you missed it: thePrenatal Diagnosiseditors bring you the most significant advances of 2014

et al. 2015

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MRI-Based Ratio of Fetal Lung Volume to Fetal Body Volume as a New Prognostic Marker in Congenital Diaphragmatic Hernia

Cited by 23 publications

References 26 publications

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update

MRT-basierter Quotient aus fetalem Lungen- und Ganzkörpervolumen als Prognosemarker für chronische Lungenerkrankung bei kongenitaler Zwerchfellhernie

In case you missed it: thePrenatal Diagnosiseditors bring you the most significant advances of 2014

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