Büsing Karen A, Kilian A Kristina, Schaible Thomas, Endler Claudia, Schaffelder Regine, Neff K Wolfgang
Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
Radiology. 2008 Jul;248(1):240-6. doi: 10.1148/radiol.2481070952.
To retrospectively evaluate the accuracy of the absolute fetal lung volume (FLV) measured at magnetic resonance (MR) imaging and seven formulas for calculating relative FLV to predict neonatal survival and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH).
This retrospective study was approved by the research ethics committee, and informed consent was received from all mothers for previous prospective studies. In total, 68 fetuses with CDH were assessed by using MR image FLV measurement within 23-39 weeks gestation. The relative FLV was expressed as a percentage of the predicted lung volume calculated with biometric parameters according to seven formulas previously described in the literature. Applying the area under the curve (AUC), the various relative FLVs and the absolute FLV were investigated for their prognostic accuracy to predict neonatal survival and the need for ECMO therapy.
All relative FLVs and the absolute FLV revealed a significant difference in mean lung volume between neonates who survived and neonates who did not survive (P = .001 to P < .001) and measurement accuracy was excellent for each method (AUC, 0.800-0.900). For predicting neonatal ECMO requirement, differences in FLVs were smaller but still significant (P = .05 to <.009) and measurement accuracy was acceptable throughout (AUC, 0.653-0.739).
The various relative FLVs and the absolute FLV measured at MR planimetry are each highly valuable in predicting survival in fetuses with CDH. For predicting whether neonatal ECMO therapy is required, the accuracy of the absolute FLV (AUC, 0.68) and that of the relative FLVs (AUC, 0.653-0.739) was acceptable.
回顾性评估磁共振成像（MR）测量的胎儿肺绝对体积（FLV）以及七种计算相对FLV的公式在预测先天性膈疝（CDH）胎儿的新生儿生存及体外膜肺氧合（ECMO）需求方面的准确性。
本回顾性研究经研究伦理委员会批准，所有母亲均已为先前的前瞻性研究签署知情同意书。共有68例CDH胎儿在妊娠23 - 39周内接受了MR图像FLV测量评估。相对FLV表示为根据文献中先前描述的七种公式用生物测量参数计算出的预测肺体积的百分比。应用曲线下面积（AUC），研究各种相对FLV和绝对FLV在预测新生儿生存及ECMO治疗需求方面的预后准确性。
所有相对FLV和绝对FLV在存活新生儿与未存活新生儿的平均肺体积方面均显示出显著差异（P = 0.001至P < 0.001），且每种方法的测量准确性均极佳（AUC，0.800 - 0.900）。对于预测新生儿ECMO需求，FLV的差异较小但仍具有显著性（P = 0.05至< 0.009），且整体测量准确性尚可（AUC，0.653 - 0.739）。
MR平面测量中测得的各种相对FLV和绝对FLV在预测CDH胎儿的生存方面均具有很高价值。对于预测是否需要新生儿ECMO治疗，绝对FLV（AUC，0.68）和相对FLV（AUC，0.653 - 0.739）的准确性尚可。
