Gorincour G, Bouvenot J, Mourot M G, Sonigo P, Chaumoitre K, Garel C, Guibaud L, Rypens F, Avni F, Cassart M, Maugey-Laulom B, Bourlière-Najean B, Brunelle F, Durand C, Eurin D
Department of Pediatric Radiology, La Timone Children's Hospital, Marseilles, France.
Ultrasound Obstet Gynecol. 2005 Dec;26(7):738-44. doi: 10.1002/uog.2618.
To investigate the correlation between fetal lung volume (FLV), measured with magnetic resonance imaging (MRI), and postnatal mortality in newborns with prenatally diagnosed isolated congenital diaphragmatic hernia (CDH).
In a 4-year prospective multicenter study, 77 fetuses with isolated CDH diagnosed between 20 and 33 weeks' gestation underwent fast spin-echo T2-weighted lung MRI. These MRI-FLV measurements were compared with a previously published normative curve obtained in 215 fetuses without thoracoabdominal malformations and with normal ultrasound biometric findings. FLV measurements were correlated with postnatal survival. The mean gestational age at MRI was 31.3 weeks.
The measured/expected FLV ratio was significantly lower in the newborns with CDH who died compared with those who survived (23.6 +/- 12.2 vs. 36.1 +/- 13.0, P < 0.001). When the ratio was below 25%, there was a significant decrease in postnatal survival (19% vs. 40.3%, P = 0.008). Survival was significantly lower for neonates when one lung could not be seen by fetal MRI compared with those fetuses with two visible lungs on MRI (17.9% vs. 62.1%, P < 0.001).
In isolated CDH, FLV measurement by MRI is a good predictor of postnatal mortality due to pulmonary hypoplasia.
研究采用磁共振成像（MRI）测量的胎儿肺容积（FLV）与产前诊断为单纯先天性膈疝（CDH）的新生儿出生后死亡率之间的相关性。
在一项为期4年的前瞻性多中心研究中，77例妊娠20至33周时诊断为单纯CDH的胎儿接受了快速自旋回波T2加权肺部MRI检查。将这些MRI-FLV测量值与之前发表的在215例无胸腹畸形且超声生物测量结果正常的胎儿中获得的正常曲线进行比较。FLV测量值与出生后存活率相关。MRI检查时的平均胎龄为31.3周。
与存活的CDH新生儿相比，死亡的CDH新生儿的测量/预期FLV比值显著更低（23.6±12.2对36.1±13.0，P<0.001）。当该比值低于25%时，出生后存活率显著降低（19%对40.3%，P=0.008）。与MRI上可见两肺的胎儿相比，胎儿MRI检查时看不到一侧肺的新生儿存活率显著更低（17.9%对62.1%，P<0.001）。
在单纯CDH中，通过MRI测量FLV是肺发育不全所致出生后死亡率的良好预测指标。
