Neff K Wolfgang, Kilian A Kristina, Schaible Thomas, Schütz Eva-Maria, Büsing Karen A
Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
AJR Am J Roentgenol. 2007 Dec;189(6):1307-11. doi: 10.2214/AJR.07.2434.
The purpose of this study was to use logistic regression analysis of prenatal MRI fetal lung volume measurements to calculate mortality and the need for extracorporeal membrane oxygenation (ECMO) therapy among fetuses with congenital diaphragmatic hernia (CDH).
The fetal lung volume measurements of 65 fetuses with CDH were obtained between 32 and 34 weeks' gestation by means of MRI performed with multiplanar T2-weighted HASTE and true fast imaging with steady-state precession sequences. Logistic regression analysis was used to assess the prognostic value of the fetal lung volume measurements for prenatal prediction of fetal survival and need for neonatal ECMO.
Fetal lung volume was a highly significant predictor of survival (p < 0.0001) and neonatal ECMO requirement (p = 0.0006). The mortality was 84% and the ECMO requirement 80% among fetuses with a lung volume of 5 mL. The mortality was 0.4% and the ECMO requirement 20% among patients with a fetal lung volume of 30 mL.
Logistic regression analysis of MRI fetal lung volume measurements is highly valuable in predicting mortality among neonates with CDH, and it may help to estimate the need for neonatal ECMO. The method is feasible for facilitating parental guidance and may help in choosing postnatal therapeutic options, including ECMO therapy.
本研究旨在利用产前磁共振成像（MRI）对胎儿肺容积测量结果进行逻辑回归分析，以计算先天性膈疝（CDH）胎儿的死亡率及体外膜肺氧合（ECMO）治疗需求。
在妊娠32至34周期间，通过多平面T2加权快速自旋回波（HASTE）序列及稳态进动快速成像序列进行MRI检查，获取65例CDH胎儿的肺容积测量结果。采用逻辑回归分析评估胎儿肺容积测量结果对产前预测胎儿生存及新生儿ECMO需求的预后价值。
胎儿肺容积是生存（p < 0.0001）及新生儿ECMO需求（p = 0.0006）的高度显著预测指标。肺容积为5 mL的胎儿死亡率为84%，ECMO需求率为80%。胎儿肺容积为30 mL的患者死亡率为0.4%，ECMO需求率为20%。
对MRI胎儿肺容积测量结果进行逻辑回归分析在预测CDH新生儿死亡率方面具有很高价值，可能有助于评估新生儿ECMO需求。该方法便于为家长提供指导，且有助于选择包括ECMO治疗在内的产后治疗方案，具有可行性。
