1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Baden-Württemberg, Germany.
AJR Am J Roentgenol. 2014 Jun;202(6):1330-6. doi: 10.2214/AJR.13.11023.
The objective of our study was to evaluate the prognostic accuracy of the MRI-based ratio of fetal lung volume (FLV) to fetal body volume (FBV) for predicting survival and the need for extracorporeal membrane oxygenation (ECMO) therapy in fetuses with congenital diaphragmatic hernia (CDH).
MRI was performed in 96 fetuses (34 females and 62 males; mean gestational age, 33 ± 5 [SD] weeks; range, 23-39 weeks) with CDH and 44 healthy control subjects. FLV and FBV were measured for each fetus by one of three investigators, and we calculated the FLV/FBV ratio. Additionally, a subgroup analysis of growth-restricted fetuses was performed. Logistic regression analysis was used to model the dependence of survival and ECMO requirement on the FLV/FBV ratio. Prognostic accuracy was evaluated by applying the area under the curve (AUC).
Seventy-eight of the 96 (81%) fetuses survived and 35 (36%) neonates needed ECMO therapy. The FLV/FBV ratio was significantly higher in fetuses who survived (p < 0.0001; AUC = 0.829). Neonates who received ECMO therapy showed a significantly lower prenatal FLV/FBV ratio (p = 0.0001; AUC = 0.811) than neonates who did not need ECMO therapy. A subgroup analysis (n = 13) showed a trend toward a higher FLV/FBV ratio of survivors in comparison with nonsurvivors (p = 0.065; AUC = 0.875).
In our study, the MRI-based FLV/FBV ratio was able to predict neonatal survival and ECMO requirement in children with CDH with high accuracy. Unlike other prognostic parameters, FLV/FBV ratio is independent of a reference to a control group and may enhance prognostic accuracy particularly in growth-restricted neonatal patients.
本研究旨在评估基于 MRI 的胎儿肺体积（FLV）与胎儿体体积（FBV）比值预测先天性膈疝（CDH）胎儿存活率和体外膜肺氧合（ECMO）治疗需求的准确性。
对 96 例（34 名女性，62 名男性；平均孕龄 33 ± 5[标准差]周；范围 23-39 周）CDH 胎儿和 44 名健康对照胎儿进行 MRI 检查。由三位研究者中的一位测量每个胎儿的 FLV 和 FBV，并计算 FLV/FBV 比值。此外，还对生长受限胎儿进行了亚组分析。采用逻辑回归分析来建立生存和 ECMO 需求对 FLV/FBV 比值的依赖性模型。通过计算曲线下面积（AUC）来评估预后准确性。
96 例胎儿中 78 例（81%）存活，35 例（36%）新生儿需要 ECMO 治疗。存活胎儿的 FLV/FBV 比值显著较高（p<0.0001；AUC=0.829）。需要 ECMO 治疗的新生儿的产前 FLV/FBV 比值明显低于不需要 ECMO 治疗的新生儿（p=0.0001；AUC=0.811）。亚组分析（n=13）显示，存活组与死亡组相比，FLV/FBV 比值有升高的趋势（p=0.065；AUC=0.875）。
在本研究中，基于 MRI 的 FLV/FBV 比值能够准确预测 CDH 新生儿的存活率和 ECMO 治疗需求。与其他预后参数不同，FLV/FBV 比值独立于对照组，可能特别在生长受限的新生儿患者中提高预后准确性。
Zotero 插件