Reproducibility of Liver‐to‐Thorax Area Ratio Ultrasound Measurements in Congenital Diaphragmatic Hernia

Abstract

Objectives The aim of this study was to investigate the reproducibility of a standardized method to assess the ultrasound liver‐to‐thoracic area ratio in fetuses with congenital diaphragmatic hernia. Methods We selected 24 images of 9 fetuses diagnosed with left‐sided at our institution between January 2010 and December 2017. Eight operators (1 maternal‐fetal medicine specialist and 7 sonographers) reviewed the selected images and assessed the ultrasound liver‐to‐thoracic area ratio according to a standardized protocol. We evaluated the correlation between operators using the intraclass correlation coefficient and compared agreement between the sonographers and a physician with experience in measuring the ultrasound liver‐to‐thoracic area ratio using a Bland‐Altman analysis. Results Good intraoperator reproducibility was observed for the standardized ultrasound liver‐to‐thoracic area ratio (intraclass correlation coefficient, 0.78). Good agreement among sonographers and the physician was also observed for the standardized measurements (bias, 0.01; precision, 0.03; limits of agreement, –0.05 to + 0.07). Conclusions We demonstrated that good intraoperator and interoperator reproducibility of ultrasound liver‐to‐thoracic area ratio assessment is feasible after standardizing the method in our center.

Reproducibility of Lung and Liver Volume Measurements on Fetal Magnetic Resonance Imaging in Left-Sided Congenital Diaphragmatic Hernia

“…In light of this, several sonographic and MRI tools have been proposed and are an integral part of prenatal CDH work up in most fetal centers. Although sonographic O/E-LHR [3] and LiTR [5] have been shown to be highly reproducible, stomach position only has a fair-to-moderate interoperator reproducibility [13]. In the present study, we evaluated the reproducibility of manually generated lung and liver volume tracings on fetal MRI.…”

“…Congenital diaphragmatic hernia (CDH), which affects 1 in 3,000 live births, is characterized by abnormal formation of the diaphragm with subsequent thoracic herniation of abdominal viscera [1]. CDH is associated with significant morbidity and mortality due to pulmonary hypoplasia and pulmonary arterial hypertension [2-5]. Fetal endoscopic tracheal occlusion (FETO) has been shown to improve lung development in severe CDH [6-10], and accurate disease prognostication is essential for appropriate selection of candidates that could benefit from FETO.…”

Magnetic Resonance Prediction of Lung Maturity in Fetuses With Congenital Diaphragmatic Hernia

“…This is felt to be due to the greater compliance of bowel compared with liver, as well as the greater volume occupied by liver containing CDHs compared with ones without liver in them. Liver to thoracic ratios also correlate well with poor outcomes 6 …”

“…Liver to thoracic ratios also correlate well with poor outcomes. 6 In the past, predictions of lung maturity were primarily based on ultrasound measurements of the contralateral fetal lung area or volume. 7 In recent years, the lung area has been normalized to fetal head measurements known as the lung head ratio.…”