The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, Pa. 19104, USA.
Fetal Diagn Ther. 2012;31(4):248-53. doi: 10.1159/000334284. Epub 2012 Apr 27.
To determine the value of fetal MRI-calculated total lung volumes (TLV) in the prediction of short-term outcome in patients with giant omphalocele (GO).
We reviewed all cases of GO undergoing fetal MRI after 21 weeks' gestation and receiving postnatal care at our institution between 2003 and 2010. Observed/expected (O/E) TLV was calculated using age-matched TLV normograms [Radiology 2001;219:236-241]. Postnatal outcomes were stratified based on O/E TLV above or below 50% of expected.
Seventeen GO cases fulfilled the entry criteria. The mean age at fetal MRI evaluation was 25.8 ± 4.8 weeks' gestation. The mean GO TLV (21.0 ± 13.2) was lower than age-matched population norms (p < 0.001), resulting in a mean O/E TLV of 52.3 ± 16.8%. The mean gestational age at delivery was 36.8 ± 1.6 weeks. Overall survival was 94%. Fourteen (88%) infants underwent staged reduction, and 2 underwent silver sulfadiazine treatment and delayed repair. Infants with ≤50% of predicted O/E TLV (n = 11, 65%) had lower Apgar scores at birth (p = 0.03), prolonged ventilatory support (p = 0.004), delayed oral intake (p = 0.03), and longer hospitalization (p = 0.03) compared to patients with ≥50% of expected O/E TLV. Two infants (both O/E TLV <50%) required tracheostomy placement.
In the assessment of GO fetuses, MRI-based O/E TLV of <50% was predictive of increased postnatal morbidity.
探讨胎儿 MRI 计算的全肺容积（TLV）在预测巨大脐膨出（GO）患者短期结局中的价值。
回顾性分析 2003 年至 2010 年期间在我院接受产前 MRI 检查并在我院接受新生儿治疗的 21 周后妊娠的 GO 患者。采用与年龄匹配的 TLV 标准曲线[Radiology 2001；219：236-241]计算观察/预期（O/E）TLV。根据 O/E TLV 高于或低于预期的 50%，对出生后的结局进行分层。
17 例 GO 病例符合入选标准。胎儿 MRI 评估时的平均胎龄为 25.8 ± 4.8 周。GO 的平均 TLV（21.0 ± 13.2）低于与年龄匹配的人群正常值（p < 0.001），导致平均 O/E TLV 为 52.3 ± 16.8%。分娩时的平均孕龄为 36.8 ± 1.6 周。总生存率为 94%。14 例（88%）婴儿进行了分期复位，2 例婴儿接受了磺胺嘧啶银治疗和延迟修复。O/E TLV 预测值≤50%（n = 11，65%）的婴儿出生时的 Apgar 评分较低（p = 0.03），通气支持时间延长（p = 0.004），口服喂养延迟（p = 0.03），住院时间延长（p = 0.03），而 O/E TLV 预测值≥50%的婴儿则无此情况。2 例婴儿（O/E TLV 均<50%）需要气管切开术。
在评估 GO 胎儿时，基于 MRI 的 O/E TLV<50%可预测出生后发病率增加。
