Repetitive MR measurements of lung volume in fetuses with congenital diaphragmatic hernia: individual development of pulmonary hypoplasia during pregnancy and calculation of weekly lung growth rates

Abstract

• Lung development in congenital diaphragmatic hernia (CDH) during pregnancy is extremely variable. • MRI demonstrates that lung growth rate is reduced in fetuses with CDH. • The final observed-to-expected fetal lung volume provides the best prognostic information. • Follow-up measurements are advisable before deciding upon therapeutic options.

Fetal lung growth represented by longitudinal changes in MRI‐derived fetal lung volume parameters predicts survival in isolated left‐sided congenital diaphragmatic hernia

“…Previous reports have reported the prognostic value of these parameters along with respective suggested cut‐off values, of which we had similar findings . However, our current study not only compares the association of these prenatal variables to outcome but also evaluates the association relative to the gestational period of evaluation.…”

“…Interestingly, this was not the case with Δo/e TLV, which is standardized to the expected lung volume of a gestational age matched control. Recently, Hagelstein et al reported a similar conclusion of slower lung growth in CDH fetuses as determined by the weekly change in fetal lung volume . Compared with that study, we additionally evaluated the rate of change in other currently employed MRI volume parameters and found no significant difference between survivors and non‐survivors.…”

“…In regard to PPLV, the measure itself may likely be very susceptible to surrounding somatic growth such as an abnormally increased rate of thoracic growth and/or impaired cardiac development related to herniated organs . On the other hand, o/e TLV had a more variable course as reported by similar studies . This may be related to its standardization to a normal fetus at the same gestational age with the more negative rates representing the most severely affected hypoplastic lungs.…”

Separate Evaluation of the Ipsilateral and Contralateral MR Fetal Lung Volume in Patients With Congenital Diaphragmatic Hernia

“…These results agree with a previous study evaluating serial MR examinations in CDH during pregnancy [23]. According to our results, development of FLV in fetuses with CDH during the course of pregnancy is variable with the possibility of decreasing, stable, and increasing observed-to-expected MR FLV.…”

“…According to our results, development of FLV in fetuses with CDH during the course of pregnancy is variable with the possibility of decreasing, stable, and increasing observed-to-expected MR FLV. An observed-to-expected MR FLV measured near birth shows a higher prognostic accuracy in predicting mortality and need for ECMO when compared with an observed-to-expected MR FLV measured earlier in gestation [23].…”