Prenatal diagnosis of fetal respiratory function: evaluation of fetal lung maturity using lung‐to‐liver signal intensity ratio at magnetic resonance imaging

Oka, Y.; Rahman, Mosiur; Sasakura, Chihaya; Waseda, T.; Watanabe, Yukio; Fujii, Ryota; Makinoda, S.

doi:10.1002/pd.4469

Cited by 21 publications

(26 citation statements)

References 22 publications

(48 reference statements)

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“…We hypothesized that when ipsilateral lung was not detected at the apex, contralateral lung maturity provided important prognostic information. We selected LLSIR values greater than 2.0 as indicative of maturity (11) validated this as predictive of outcome, suggesting that this value reflects contralateral lung maturation. When values were less than 2.0, contralateral lung maturation was insufficient to support survival (Grade III), whereas contralateral lung maturation was more likely to allow survival (Grade II), although with a requirement for intensive management using iNO or ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…Stratification was performed utilizing coronal sections of T2-weighted MRI studies obtained after 29 weeks of gestation. LLSIR was calculated by the study radiologist (Y Sugioka) as reported by Oka et al (11). We placed one region of interest (ROI) within the homogenous portion of the liver and the contralateral lung on the same section.…”

Section: The Stratification Algorithmmentioning

confidence: 99%

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A new approach to risk stratification using fetal MRI to predict outcomes in congenital diaphragmatic hernia: the preliminary retrospective single institutional study

Yokoi¹,

Ohfuji²,

Yoshimoto³

et al. 2018

Transl Pediatr

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Background: Congenital diaphragmatic hernia (CDH) is a condition with a wide range of severity.Prenatal diagnosis is essential to optimize postnatal management, especially for severe cases. The lung to head ratio (LHR) and liver herniation estimated by prenatal ultrasound has been used as prenatal predictors in CDH. However, reliability of these factors remains to be proven and prediction of outcome from prenatal imaging is still challenging. We propose our new stratification system using lung to liver signal intensity ratio (LLSIR) in fetal MRI, which has been shown to be related to pulmonary maturation.Methods: Retrospective chart review was conducted on 25 infants with CDH treated from 2009 through 2016 in our hospital. We stratified patients according to fetal T2-weighted MRI as Grade I, detectable ipsilateral lung at the apex; Grade II, undetectable ipsilateral lung at the apex and contralateral LLSR ≥2.0; Grade III, undetectable ipsilateral lung at the apex and contralateral LLSR <2.0. To evaluate this stratification system, we analyzed survival, severity [inhaled nitric oxide (iNO) usage with or without extracorporeal membrane oxygenation (ECMO)], and requirement of patch closure.Results: All 15 patients survived in Grade I, while 2 out of 6 died in Grade II, and 3 out of 4 died in Grade III (P=0.003). Four were severe in Grade I, and all in Grade II and III who survived (P=0.007). One needed patch in Grade I, and all in Grade II and III (OR: 414,238,332; 95% CI, 0-∞). Liver herniation was noted in five patients, and significantly associated with survival (P=0.04), however, neither with severity (P=1.00) nor with the requirement of patch closure (P=0.52). Conclusions:The risk stratification algorithm using contralateral LLSIR in fetal MRI could be useful and more reliable than liver herniation to predict survival, severity, and need of patch closure. Further investigation is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: The Stratification Algorithmmentioning

confidence: 99%

A new approach to risk stratification using fetal MRI to predict outcomes in congenital diaphragmatic hernia: the preliminary retrospective single institutional study

Yokoi¹,

Ohfuji²,

Yoshimoto³

et al. 2018

Transl Pediatr

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“…The SSFSE sequence technique also allows clear visualization of the aortic arch anatomy. To account for effects of fetal movement, we repeated sequences that were degraded by fetal motion [6] . Fetal MRI may also provide relevant information on lung volume and signal intensity, and is an accurate prenatal method for evaluating fetal lung maturity using the lung-to-liver signal intensity ratio on T2-weighted images [5] .…”

Section: Discussionmentioning

confidence: 99%

Fetal MRI diagnosis of 2 types of left pulmonary artery sling

Saul

et al. 2017

Radiology Case Reports

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We report on 2 different types of left pulmonary artery sling (LPAS), types IA and IIB, diagnosed by fetal magnetic resonance imaging (MRI). We suggest that fetal MRI is an effective tool for accurately diagnosing LPAS and helping guide its perinatal management. Fetal MRI is relatively unaffected by the conditions that limit visualization by echocardiography. When prenatal ultrasound detects either a possible anomalous origin of the left pulmonary artery or a tracheobronchial anomaly, fetal MRI may provide additional information to confirm the LPAS diagnosis and classify its type. To our knowledge, these are the first reports of prenatally diagnosed LPAS by fetal MRI.

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“…Low lung signal intensity is considered to reflect a low lung fluid volume, which is associated with pulmonary hypoplasia. 6,8,9 Although LLSIR positively correlated with gestational age, normalization according to gestational age was not performed in these studies. 6,8,9 In the present study, we constructed the reference range of LLSIR for normal fetuses and retrospectively assessed the use of LLSIR to predict functional pulmonary hypoplasia (FPH) with respect to gestational age.…”

Section: Introductionmentioning

confidence: 89%

Prenatal evaluation of functional pulmonary hypoplasia via fetal magnetic resonance imaging

Sakuma

Nakata

Takano

et al. 2021

J of Obstet and Gynaecol

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Objective: The purpose of this study was to retrospectively examine the use of lung-to-liver signal intensity ratio (LLSIR) on T2-weighted images to predict functional pulmonary hypoplasia. Methods: The subjects of this study were pregnant women who underwent magnetic resonance imaging (MRI). Patients who required nitric oxide inhalation and those who died from respiratory disorders were classified as having functional pulmonary hypoplasia (FPH). All other cases were presented as the control group. We retrospectively analyzed MRI and perinatal data. LLSIR was defined as the ratio of lung signal intensity to liver signal intensity. We examined the relationship between LLSIR and gestational age, compared the LLSIRs in the two groups, and calculated the best cut-off value of the LLSIR to predict FPH. Results: One hundred and ninety-one patients were eligible for this study, and 12 cases were classified as having FPH. In the control group, LLSIR increased with age (r = 0.383, p < 0.001). We used the observed/ expected LLSIR (o/e LLSIR), which was the ratio of obtained LLSIR to expected LLSIR calculated by the regression line to correct the effect of gestational age. In the FHP group, o/e LLSIR was significantly lower than in the control group (p < 0.001). A receiver operating characteristic curve analysis showed that cases with o/e LLSIR above 0.85 were less likely to cause FPH. Conclusions: Low o/e LLSIR might reflect the histological characteristics of hypoplastic lung structures. O/e LLSIR seems to be a useful MRI parameter for screening FPH.

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Prenatal diagnosis of fetal respiratory function: evaluation of fetal lung maturity using lung‐to‐liver signal intensity ratio at magnetic resonance imaging

Cited by 21 publications

References 22 publications

A new approach to risk stratification using fetal MRI to predict outcomes in congenital diaphragmatic hernia: the preliminary retrospective single institutional study

A new approach to risk stratification using fetal MRI to predict outcomes in congenital diaphragmatic hernia: the preliminary retrospective single institutional study

Fetal MRI diagnosis of 2 types of left pulmonary artery sling

Prenatal evaluation of functional pulmonary hypoplasia via fetal magnetic resonance imaging

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