The relationship between three signs of fetal magnetic resonance imaging and severity of congenital diaphragmatic hernia

Hattori, Tetsuo; Hayakawa, Masahiro; Ito, Motokazu; Sato, Yoshiaki; Koji, Takehiko; Kanamori, Yutaka; Okuyama, Hiroomi; Inamura, Noboru; Takahashi, Satoshi; Fujino, Yuji; Taguchi, Tomoaki; Usui, Noriaki

doi:10.1038/jp.2016.208

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…Median gestational age and birth weight were 37 weeks (range, 37-39 weeks), 2,932 g (range, 2,378-3,502 g) in Grade I, 37 weeks (range, 37-38 weeks), 2,570 g (range, 2,466-3,018 g) in Grade II and 33 weeks (range, 32-37 weeks), 2,129 g (range, 1,652-2,510 g) in Grade III (P=0.01, 0.007, respectively). Median Apgar scores at 1 and 5 minutes were 3 (range, 2-8), 6 (range, [3][4][5][6][7][8][9] in Grande I, 2 (range, 1-3), 4.5 (range, 4-5) in Grade II, and 3 (range, 1-3), 3.5 (range, 1-4) in Grade III (P=0.09, 0.03, respectively). iNO was used for 4 (26.7%) patients in Grade I, all patients in Grade II and 1 in Grade III (P=0.007).…”

Section: Resultsmentioning

confidence: 92%

“…Although total lung volume has been demonstrated to correlate with prognosis, adjustment of these calculations by gestational age or fetal body weight is not always feasible or available. Considering the difficulty of measurement of lung volumes with MRI, a morphologic study may be preferable (7). Liver herniation into the chest and the position of the stomach have been evaluated as alternative prognostic factors (8).…”

Section: Introductionmentioning

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: Resultsmentioning

confidence: 92%

Section: Introductionmentioning

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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“…Hernial contents related to the prognosis of neonates, such as the liver or stomach, were detected by both postnatal US and prenatal MRI . Notably, a small subset of hernial contents, such as the pancreas, might be more easily detected by postnatal US than by prenatal MRI because the former provides good image resolution.…”

Section: Discussionmentioning

confidence: 99%

Postnatal Ultrasound to Determine the Surgical Strategy for Congenital Diaphragmatic Hernia

Hosokawa

Yamada

Takahashi

et al. 2019

J of Ultrasound Medicine

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Objectives-To compare defect sizes in congenital diaphragmatic hernia (CDH) measured by postnatal ultrasound (US) between neonates who underwent thoracoscopic surgery and neonates who underwent open surgery and between neonates who underwent primary repair and those who underwent patch repair; additionally, to compare the accuracy of US diagnosis with that of surgical diagnosis for the location of the diaphragmatic hernia and the hernial contents.Methods-We included 8 neonates who underwent preoperative US evaluations of CDH. We compared anterior-to-posterior diaphragm defect sizes between thoracoscopic and open surgery approaches and between primary and patch repair by using the Mann-Whitney U test. The diaphragm was divided into 3 segments: anterior, lateral, and posterior. We evaluated the location of the diaphragmatic hernia and the hernial contents.Results-Four neonates who underwent open surgery had larger diaphragmatic hernias than those who underwent thoracoscopic surgery (mean AE SD, 30.5 AE 5.6 versus 16.3 AE 3.3 mm; P = .030). They were also larger in neonates who underwent patch repair than in those who underwent primary repair (33.0 AE 3.0 versus 17.6 AE 4.2 mm; P = .037). Detection of anterior and lateral diaphragm segments was consistent between US and surgical findings. Three of 4 neonates who underwent open surgery and all 3 neonates who underwent patch repair did not show the lateral segment. The hernial contents were also consistent between US and surgical findings.Conclusions-Postnatal US examinations of neonates with CDH could provide surgeons with useful information to determine the surgical approach and repair method. However, since our study cohort was small, further studies are needed with a larger number of neonates with CDH.

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Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis

et al. 2022

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This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). MethodsA systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. ResultsA total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identi ed a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 (95% con dence interval (CI), 4. 11.14 (95%CI, and 10.28 (95%CI,, respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. ConclusionsThis systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.

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The relationship between three signs of fetal magnetic resonance imaging and severity of congenital diaphragmatic hernia

Abstract: IPB, LU and RCS on fetal MRI are related to CDH severity.

Cited by 5 publications

References 26 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

Postnatal Ultrasound to Determine the Surgical Strategy for Congenital Diaphragmatic Hernia

Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis

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