Paek B W, Coakley F V, Lu Y, Filly R A, Lopoo J B, Qayyum A, Harrison M R, Albanese C T
Department of Surgery, Fetal Treatment Center, University of California, San Francisco, 513 Parnassus Ave, Rm HSW 1601, San Francisco, CA 94143-0570, USA.
Radiology. 2001 Jul;220(1):63-7. doi: 10.1148/radiology.220.1.r01jl4163.
To determine the interobserver variability of prenatal magnetic resonance (MR) lung volumetry and to assess the value of MR lung volumetric findings as predictors of outcome in fetuses with congenital diaphragmatic hernia.
Prenatal MR imaging was performed in 26 fetuses with unilateral congenital diaphragmatic hernia. Two independent observers performed planimetric measurement of lung volume. Relative lung volume was calculated as the observed total lung volume expressed as a percentage of the total lung volume predicted from fetal size. Relative lung volume was correlated with the ultrasonographic lung-head ratio in left-sided congenital diaphragmatic hernias evaluated before 27 weeks gestation (n = 21) and with pregnancy outcome in all cases of isolated left-sided congenital diaphragmatic hernia without prenatal intervention (n = 11).
Observers demonstrated excellent agreement in total lung volume measurements at MR imaging, with an intraclass correlation coefficient of 0.95. Relative lung volume was positively correlated with lung-head ratio (r = 0.78, P <.001). By using rank order analysis in the pregnancy outcome group, relative lung volume was predictive of prognosis (P <.05) when adjusted for gestational age at delivery and birth weight. Three of four fetuses with a relative lung volume of less than 40% died.
Interobserver agreement is high at MR lung volumetry, and its findings are predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia.
确定产前磁共振（MR）肺容积测量的观察者间变异性，并评估MR肺容积测量结果作为先天性膈疝胎儿预后预测指标的价值。
对26例单侧先天性膈疝胎儿进行产前MR成像。两名独立观察者对肺容积进行平面测量。相对肺容积计算为观察到的总肺容积占根据胎儿大小预测的总肺容积的百分比。在妊娠27周前评估的左侧先天性膈疝（n = 21）中，相对肺容积与超声肺头比相关，在所有未进行产前干预的孤立性左侧先天性膈疝病例（n = 11）中，相对肺容积与妊娠结局相关。
观察者在MR成像的总肺容积测量中表现出高度一致性，组内相关系数为0.95。相对肺容积与肺头比呈正相关（r = 0.78，P <.001）。通过对妊娠结局组进行秩次分析，在调整分娩时的孕周和出生体重后，相对肺容积可预测预后（P <.05）。相对肺容积小于40%的4例胎儿中有3例死亡。
MR肺容积测量的观察者间一致性较高，其结果可预测孤立性左侧先天性膈疝胎儿的预后。
