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

Kolbe, Amy B.; Ibirogba, Eniola R.; Thomas, Kristen B.; Hull, Nathan C.; Thacker, Paul G.; Hathcock, Matthew; Sangi‐Haghpeykar, Haleh; Ruano, Rodrigo

doi:10.1159/000512491

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…These disease manifestations are critical outcomes and will be important areas for future study. Finally, inter-reviewer reproducibility was not verified in this study, but has been demonstrated to be moderate-to-good for liver volumes above the diaphragm and good-to-excellent for liver volumes below the diaphragm after standardization ( 23 ).…”

Section: Discussionmentioning

confidence: 65%

“…All MRI scans were reviewed and reported by 2 independent fetal radiologists with combined 40 years of experience. Using this methodology, intra- and inter-reviewer reproducibility has been demonstrated to be moderate-to-good for liver volumes above the diaphragm and good-to-excellent for liver volumes below the diaphragm after standardization of the technique ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

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The interplay between prenatal liver growth and lung development in congenital diaphragmatic hernia

Ott

Scorletti

et al. 2022

Front. Pediatr.

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ObjectiveLiver herniation is a known risk factor for increased severity in CDH and is associated with clinically significant pulmonary hypoplasia and pulmonary hypertension. Better studies are needed to understand the growth of the herniated liver compared to the liver that remains in the abdomen and how this liver growth then affects lung development. Serial hi-resolution fetal MRI enables characterization of liver growth throughout gestation and examination of macroscopic features that may regulate liver growth. Here, we hypothesized that the nature of liver herniation affects liver growth and, in turn, affects lung growth.MethodsClinical data were retrospectively collected from consecutive cases of prenatally diagnosed isolated left-sided or right-sided CDH from June 2006 to August 2021. Only those cases with MRI lung volumetry for both mid-gestation and late-gestation time points were recruited for analysis. Cases with fetal chromosomal abnormalities and other major structural abnormalities were excluded. Fractional liver volume and liver growth was indexed to estimated fetal weight and compared to lung growth.ResultsData was collected from 28 fetuses with a left liver-down CDH (LLD), 37 left liver-up CDH (LLU) and 9 right liver-up CDH (RLU). Overall, RLU fetuses had greater overall and fractional (intra-thoracic vs. intra-abdominal) liver growth when compared to LLD and LLU fetuses. Additionally, intra-thoracic liver growth was consistently slower than intra-abdominal liver growth for either right- or left-sided CDH. When the liver was not herniated, a positive correlation was seen between liver growth and lung growth. However, when the liver was herniated above the diaphragm, this positive correlation was lost.ConclusionRight-sided CDH fetuses exhibit greater liver growth compared to left-sided CDH. Liver herniation disrupts the normal positive correlation between liver and lung growth that is seen when the liver is entirely within the abdomen.

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Section: Discussionmentioning

confidence: 65%

Section: Methodsmentioning

confidence: 99%

The interplay between prenatal liver growth and lung development in congenital diaphragmatic hernia

Ott

Scorletti

et al. 2022

Front. Pediatr.

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“…However, the presented results show high ICCs between segmented lung volumes for repeated acquisitions, which is likely due to the clarity of lung visualization on fetal MRI. Previous studies confirm lung segmentation can be performed reliably, even in severe pulmonary hypoplasia [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 90%

Fetal MRI radiomics: non-invasive and reproducible quantification of human lung maturity

et al. 2023

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Objectives To assess the reproducibility of radiomics features extracted from the developing lung in repeated in-vivo fetal MRI acquisitions. Methods In-vivo MRI (1.5 Tesla) scans of 30 fetuses, each including two axial and one coronal T2-weighted sequences of the whole lung with all other acquisition parameters kept constant, were retrospectively identified. Manual segmentation of the lungs was performed using ITK-Snap. One hundred radiomics features were extracted from fetal lung MRI data using Pyradiomics, resulting in 90 datasets. Intra-class correlation coefficients (ICC) of radiomics features were calculated between baseline and repeat axial acquisitions and between baseline axial and coronal acquisitions. Results MRI data of 30 fetuses (12 [40%] females, 18 [60%] males) at a median gestational age of 24 + 5 gestational weeks plus days (GW) (interquartile range [IQR] 3 + 3 GW, range 21 + 1 to 32 + 6 GW) were included. Median ICC of radiomics features between baseline and repeat axial MR acquisitions was 0.92 (IQR 0.13, range 0.33 to 1), with 60 features exhibiting excellent (ICC > 0.9), 27 good (> 0.75–0.9), twelve moderate (0.5–0.75), and one poor (ICC < 0.5) reproducibility. Median ICC of radiomics features between baseline axial and coronal MR acquisitions was 0.79 (IQR 0.15, range 0.2 to 1), with 20 features exhibiting excellent, 47 good, 29 moderate, and four poor reproducibility. Conclusion Standardized in-vivo fetal MRI allows reproducible extraction of lung radiomics features. In the future, radiomics analysis may improve diagnostic and prognostic yield of fetal MRI in normal and pathologic lung development. Key Points • Non-invasive fetal MRI acquired using a standardized protocol allows reproducible extraction of radiomics features from the developing lung for objective tissue characterization. • Alteration of imaging plane between fetal MRI acquisitions has a negative impact on lung radiomics feature reproducibility. • Fetal MRI radiomics features reflecting the microstructure and shape of the fetal lung could complement observed-to-expected lung volume in the prediction of postnatal outcome and optimal treatment of fetuses with abnormal lung development in the future.

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“…Therefore, the sequence less affected by artifacts can be chosen [ 31 , 32 ]. In addition, this method shows high reproducibility and excellent inter- and intraobserver agreement [ 29 , 32 , 33 ]. In a recent meta-analysis including four studies assessing the role of TFLV in predicting mortality, the absolute lung volume was markedly reduced in patients with poor prognosis, with a significant overall impact on survival [ 12 ].…”

Section: Mri Evaluation and Clinical Implicationsmentioning

confidence: 99%

The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia

et al. 2022

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In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity.Conclusion: Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment. What is Known:• MRI plays a key role in evaluating the fetal lung in patients with CDH.• Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling. What is New:• Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction.• Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.

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

Cited by 4 publications

References 22 publications

The interplay between prenatal liver growth and lung development in congenital diaphragmatic hernia

The interplay between prenatal liver growth and lung development in congenital diaphragmatic hernia

Fetal MRI radiomics: non-invasive and reproducible quantification of human lung maturity

The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia

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